What System am I?
I am your call system
Genesys
How long is the grace period for a member who lost Medicaid
6 months
What should you verify on every call?
HIPAA
I am Partial Medicaid but Medicaid pays the copays.
01-Partial Medicaid (QMB Only)
I am your main system that houses documentation
Maestro
What is a Coverage Determination?
A request to to cover a Part D drug
What is a retro PCP change?
a PCP change that takes place on the 1st of the current or previous month
I am Full Medicaid but Medicaid does not pay my copays
SLMB+
I am the system that you complete Health Risk Assessments in
ICUE
What is a OD?
Organization determination
A request to have the plan cover a specific medical service
What is a standard PCP change?
A PCP change that takes place on the 1st of the following month
Can a provider balance bill a QMB+ member?
NO
I am the system where you find case managers and send messages to case managers
Community Care
(Altruvista, Guiding Light)
RX:
What does Excluded mean on the formulary?
Medicare does not cover the drug
What is a cancellation?
A request to leave the plan before the plan becomes active
I am a QI member. Will I receive bills from providers?
Yes
I am the system that feeds information into Maestro. Originally the main system back in the day, if Maestro goes down, we can use this system.
GPS
RX:
Can a member request a Coverage Determination for an Excluded Drug?
Only if the member states that the drug should be covered under the Social Security Act
When searching a provider for the member, what must you do to prevent giving the member "homework"?
Call the provider to see if the information in Rally is correct. Offer to make an appointment for the member.
Besides CORE, where would I check for Medicaid source of truth?
MARx (CMS)