Group 1
If a Member's ID number starts with 0,4, or 6, Which platform is used?
NICE
Member called in to question a bill that was pertaining to her car accident. Where would we transfer the member?
Subrogation
What team handles enrollment/disenrollment disputes?
DEC
What team is responsible for handling request related to enrollment or disenrollment, and making efforts to retain the member through resolving issues and providing education?
MRC Team
What are the examples of Subrogation?
Accidental injury, slip and fall injury, work related injury or illness, motor vehicle accident
What happens to NICE claims when a member reaches claim number 999?
A new member ID will populate
Where would we direct a call regarding subrogation?
Optum: offer to warm transfer
What is a quick way to tell in a member's account if the member is deceased?
There will be no age
Which platform has a maximum on claim?
NICE
Who do we transfer the disenrollment requests?
MRC Team
Where would you find if a member is delegated?
PMG tab
Who can be added as an authorized representative on an M&R members account without having to send an authorized representative form?
Family member, significant other, spouse
which support team should we engage if the member requests to Disenroll, change their plan, cancel application, or reinstate their plan?
MRC
Member called in and locked themselves out from Uhc.com, if unable to get in by probing questions, where do we send the member?
M&R Web Support Team
Where would you find to schedule transportation?
Review Medical Benefits - Transportation
When does a standard PCP change become effective?
PCP becomes effective the 1st of the following month
Who schedules transportation for PMG member?
PCP
If a member is delegated is it possible for the transportation to be handled through the PCP office, True or False?
True
What other resource can you use besides review medical benefits to locate detailed summary of benefits?
EOC/ IBAAG
what is one way to identify a Cosmos Value based care arrangement?
Identified by the group# and contract ID/PBP # on the plan tab in the job aid Value Based Care Arrangements - Index