A
On what systems will the CPU Specialist access the member’s plan profile?
MARx and CI
When looking at the PBP number, how can you tell whether the plan is an Individual plan?
When the PBP number is not within the 800 series, the plan is a Medicare individual plan.
Humana’s systems classify and route the inquiries into virtual depositories or tanks called:
Classifications
What screen in CI is entitlement information found?
PAIG
What screen in CI displays the enrollment source?
PAIG
Each Medicare Advantage (MA/MAPD) and Prescription Drug Plan (PDP) has a set of plan identifiers.
True
How would you know from the PBP plan number that a plan is a Medicare group plan (aka, employer group health plan - EGHP)?
When a plan’s PBP number is within the 800 series the plan is a Medicare group plan (aka, employer group health plan - EGHP).
Who maintains the information in MARx?
CMS
What screen in MARx do we look for entitlement information?
Eligibility
When a transaction does not meet CMS guidelines what type of transaction reply code is received?
Rejections
What does the PBP number also indicate?
The PBP number also indicates whether the plan is individual or group.
CPU Specialists collect between three and six additional pieces of information per reply code: transaction code, plan data, tracking IDs, and Medicare ID. This information can be found in the:
Transaction Reply Report (TRR) Template
The Medicare ID is known as what in MARx?
Claim #
What is the first step to perform for resolving replies?
Pre-Work
When following the Enrollment Process Flow what happens to the electronic application after it has been received by Humana or CMS?
Enters AE
How does the Medicare system, MARx, recognize, and display Medicare Advantage (MA, MAPD) and Prescription Drug Plans (PDP)?
MARx, recognizes, and displays Medicare Advantage (MA, MAPD) and Prescription Drug Plans (PDP) by their Contract, PBP, and Segment numbers.
Why do Humana associates use MARx?
Confirm, validate, verify beneficiary information.
We can access MARx to view and verify what types of beneficiary information?
Name, date of birth, date of death, gender, Medicare ID/MBI, Parts, A, B, and D, Eligibility Dates, LIS information
When working CMS Error/Preprocessor Inquiries CPU Specialists update what two systems to match?
CI & MARx
How many enrollment sources are there?
4
What does the full plan identifier contain?
Contract, Plan Benefit Package (PBP), and Segment numbers.
The home screen upon logging into CI.
PAPI
MBI =
Medicare ID Number
OSB =
Optional Supplemental Benefit
What 4 types of transactions are accepted by CMS?
Enrollment, Disenrollment, Cancellation of Enrollment, Cancellation of Disenrollment