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What is the standard TAT for the member recievStandard shipping: 8 to 10 days from request date,ing an ID card.
Standard shipping: 8 to 10 days from request date,
What does release of Level I information include?
Basic details and general knowledge
What is a Medicare Advantage plan?
A private insurance plan that provides Medicare benefits and may include extra services
What is a key feature of an HMO (Health Maintenance Organization) plan?
You must choose a Primary Care Doctor and get referrals to see a specialist.
What is the website that our members can use to see their benefits, print forms and temporary ID cards, and check their claim information?
What is the date range for the Annual Enrollment Period (AEP) for Medicare?
October 15 to December 7
When a member submits for a claim reimbursement, what system can we check to confirm delivery?
Electronic Correspondence Handling System (ECHS)
What is a message code on a claim used for?
To communicate any issues or reasons for claim denial.
What does enrollment cancellation mean?
It is when a member decides to stop their enrollment in a plan prior to the plan’s effective date.
What system houses Medicare appeals, grievances, and case tracking messages (CTMs)?
MedHok
Which NextGen system would you use to see enrollment submissions, disenrollment submissions, and member account changes?
Market Prominence
What does "Coordination of Benefits" mean?
Medicare members may have more than one active insurance policy
What does procedure code 72141 describe when you look it up using Service Code Inquiry?
Magnetic image, neck spine
What happens if a member moves out of their service area?
They will qualify for a Special Election Period (SEP) to choose a new plan
When might you need to use EPDB?
When you may need to verify a doctor’s network status outside of GPS.
What is the main difference between a Primary Care Physician and a Specialist?
Primary Care Physician treats general health issues, while a Specialist focuses on specific medical areas.
Who is eligible for a Medicare Advantage plan?
People who are 65 or older, or those under 65 with certain disabilities
What is a copayment?
A dollar amount you pay for a specific medical service or prescription at the time you receive it
What is the document sent to our members that explain how claims were processed?
Explanation of Benefits
When would you do a temporary address change?
When a member is staying at a different address for a short time, like during a vacation or while visiting family
Which status of a claim can be sent back for rework?
Final
What information is included in the Monthly Explanation of Benefits?
Breakdown of medical procedures and member cost
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What internal support team can assist you with
researching enrollment eligibility inquiries for Medicare
members?
Medicare Internal Urgent Support Team (MIUS
Prior to updating a member’s name, date of birth,
Medicare Beneficiary Identifier (MBI) or gender, what
system must you verify that information in?
MARx
What tab in HRP will you find a breakdown of the claim payment?
Financial History