KPIF PLANS
True or false: Setting up automatic payments is the preferred payment method for KPWA.
True
What is the name of the Medicare enrollment/election period between January 1-March 31st?
MA OEP
Which identifier will always be used as one identifier
First and last name
Effective 1/1/2026 The premium will increase from - to - per month.
$18 to $22 per month
If a caller is checking the status of their enrollment on a KPIF plan, but they’re not in eWatson, where will you check for enrollment information?
MQV
When can an Individual Medicare Advantage (MA) member add Advantage Plus 1 (Optional Supplemental) to their plan?
October 15-March 31
Can benefit information for Minor member under the age of 18 be discussed without verbal authorization
yes
Advantage plus 2 covers what :
Hearing aid
non-emergency/ transportation rides
Acupuncture and Chiropractic
Which flow will you use to document calls regarding accounts in Epic?
patients account
ACI Client Console for premium payment is used only for Medicare advantage members
false
How can you identify if a claim is pending?
Location in eWatson will show “Online”
what application can we review to locate applicable Legal Documents authorizing the caller to speak on behalf of the member.
Epic
Which applications can we use to order Individual EOCs, ANOCs, Formulary, Pharmacy and Provider Directories
Order through ONEClick/ONEsuite
If an account in Epic shows BILLED [Bad Debt] with an SP Balance - how would you assist the caller?
Soft transfer/connect the call to the appropriate collection agency.
What's the appropriate way to login into ACI
The Login ID field requires your NUID and an added Zero at the end of your NUID.
Login ID: NUID+0 (Example: d1234560), the letter in your NUID will need to be lowercase.
if a current member with questions about formulary, tiers, costs of prescription you can answer them
no transfer to optum
true or false :Autopay can only be set up by the policy holder/subscriber or with policy holder’s authorization.
true
What letter can you order if you need Proof of insurance
Letter – Effective/Termination Date
What would you mark for Estimated Time Frames when filing a complaint ?
yes
what Tool is used for KPIF Off Exchange prospective members and allows representatives to view information about the application
The Application Management Tool
what does a complete benefit include
Member responsibility (benefit)
· Limits (if needed)
· Network (who they can see and be covered)
· Authorization
Can a Priority Note be used for member behavioral issues.
no
Which tab can you see premium payments inside of EWATSON
subscriber
If a member is disputing a charge in Epic stating the services were preventive, how will you assist?
Send a Patient Account flow in eWatson and request a Chart Review