Mon and George
Tool to check if the member has straight Medicaid?
DMEVS
Member lost her id card. What tool can you use to send a new ID Card?
GPS
FOCUSING ON SOLVING ISSUES THAT CAUSE OUR MEMBERS AND PROVIDERS FRUSTRATION AND ADDITIONAL EFFORT.
Embracing the Gray
Who is the OTC vendor for MI state ?
FirstLine Medical
You can use me to check the status of an appeal and grievance
Escalation Tracking System (ETS)
Tool where you can see the profile and claims of the member?
Facets
Member is not happy with how she was treated in the doctor’s clinic when she went for a check-up and wants to lodge a complaint against the receptionist. In what tool do we initially document the complain?
Macros
Management tool that can be used to gauge the loyalty of a firm's customer relationships
Net Promoter or Net Promoter Score (NPS)
Where can you find the Annual Wellness Visit?
Screenings and Exam
What is the turn around time for an expedited Coverage Determination?
24 hrs
Tool where you can verify the Medicaid eligibility of the member
Marx Lookup
Member wants to know the phone number of the pharmacy she visited previously to get her prescribed medicine. What tool can you use to get the information?
RxClaim
ADMINISTERS MEDICARE AND OVERSEES MEDICAID AND D-SNP PLAN ADMINISTRATORS
Federal Government
Where to find Prophylaxis benefit ?
Dental/Oral Benefits
What are the 2 types of grievances?
Standard and Quality of Care
Tool where you can see all the information with the different scenario including Job Aids and SOPs
Knowledge Central
Member provided the phone number of a doctor to confirm if the doctor can replace her existing PCP. What tool can we use to confirm?
Facets
OCCURS WHEN A MEMBER LOSES ELEGIBILITY UNDER MEDICARE OR MEDICAID
Disenrollment
In what benefit type can you check the cystogram exam if covered?
Diagnotics Test
The advocate cannot discuss the member's ___________ to an Authorized Representative on the account.
Sensitive Information
tool where you can see the detailed Vision benefit of the member
Eyesynergy
Member wants to know what she can do after finding out that a medicine she was prescribed is not covered. Agent will check if an existing request was filed for authorization. Where can an agent use to check?
PAS
What are the Medicaid Eligibility categories?
QMB ONLY
QMB PLUS
SLMB
SLMB PLUS
QI
QDWI
FBDE
Where can you check find the mental health benefits of the member?
Behavioral Health
What is the Birth month of your Trainer?
June