General LI NET/G&A
A Unique, Medicare Part D Prescription Drug Program
LI NET (Limited Income Newly Eligible Transition)
What is an Executor of Estate (EOE)
What must be ran for each call received.
What is BESST query
What is process to complete to replace a check.
What is Trace and Replace
Edit 3
What is when a member has either current LI NET coverage or another part D plan.
They are enrolled in a LI NET plan in CI, or They are no longer enrolled in an LI NET plan, but the issue happened when they were enrolled, and it is within 60 days of the coverage period end date or incident.
What is scenarios where a beneficiary will have Grievance and Appeal Rights
The CMS Regional Worker’s name, region number, and city in which region is based
What is information required to verify a CMS Regional Worker's Authority
Notes that are needed if a pharmacy is call regarding current DOS and the beneficiary passes all edits in BESST?
What is no notes needed (would use new notes approach)
Claims Rework Issues or Check issue you may receive.
What is where E-Room requests are needed.
Edit 2
What is an edit that is received when a member either does not have Part A/B coverage for requested DOS or is showing deceased in Medicare System (MARX)
Three transitions, or gaps to where a low income beneficiary may be eligible for LI NET.
What are Medicaid beneficiary (or other qualifying Extra Help program beneficiary) becomes newly entitled to Medicare, and becomes dual-eligible, Medicare beneficiary newly qualifies for Medicaid (or other qualifying Extra Help program), and becomes dual-eligible, Dual-Eligible beneficiary is disenrolled from their Part D coverage and needs a Part D plan until they can select new coverage.
The Provider's Tax Identification Number or NPI and The Provider's Name or Facility Name.
What is Elements for verifying a provider's authority
The Disposition Code Field
What is where you would look in your Stand along query to determine what edit the beneficiary failed.
Check Status Tool
What is where to locate the status of a check
Edit 4
What is when a beneficiary is enrolled in a Medicare Part C Plan. Member may be eligible for enrollment in a stand-along Part D plan
A person is entitled to both Medicare and Medicaid benefits.
What is Dual-Eligible
Unique Member ID Number/MBI or UMID, DOB, Zip Code
What are pieces of information that are required to authenticate a inbound Medicare member.
Where you would look to view previous queries and responses in BESST.
What is Previous Queries
Payment History Tab
What is where to find payment date.
Edit 6
What is an Edit that is received when a member has Opted out of Medicare Part D Enrollment.
Auto-Assigned Enrollment, Point of Sale Enrollment and Direct Member Reimbursement (DMR)
What are the types of enrollment into LI NET
Thank you for calling the Limited income NET Program. This is Marie. How can I help you today?
What is the proper LI NET greeting
You receive a Edit 0 for retro dates of service, and there are no lawfully present or incarceration statuses noted in MARx, what is your next step?
What is dynamically add
Outstanding – Payment processed, but not yet released, Released – payment released and mailed but not yet cashed, Cleared – cashed check that has cleared, Void – voided check, Stop Pay – indicates a stop payment was issued
What is different status types in RX Nova Connect.
Edit 7
What is an Edit that is received when a member does not have LIS for requested date of service.