IFP
True or False: Members enrolled on a state-funded plan are eligible to be reimbursed
False
This is when you have to have your Medicare Certification complete
December 31st Annually
Letters needing to be sent that day need to be in the mail folders by this time.
2:00 pm
How many attempts are needed to make on an oral grievance
3
UCare has an IFP plan with this hospital system.
M Health Fairview
PMAP plans are eligible for which type of members?
Adults, Children and families ages 0-64 that qualify for Medical Assistance
This is the TAT for a Part D Standard Appeal
7 Calendar days
This is where you find the faxes in Guiding Care
Under CM Module and then Type of Faxes
These words are considered in what category
-Expedited, Urgent, Immediate, Fast, Life Threatening
Accepted expedited words
An expedited non-formulary exception appeal has how many hours for review?
72 Hours
Dual plans are handled by the state team for which types of appeals?
Elderly Waiver, PCA, RR Appeals, Care Coordinators
An Acknowledgement letter is only required for this type of Medicare case
Written Grievances
Cases needing QA need to be sent how many days before due.
3+ days
Ucare works with which two regulators
MN Dept of Commerce and MN Dept of Health
Open enrollment will be during this timeframe for 2026 plans.
November 1 2025 through December 15, 2025
Restricted Recipient Appeals Must be received within how many days?
60 days
What appeal decisions require a Maximus packet?
Claims UH, Partially UH, Service UH, Partially UH
This is how many locations intake checks for appeals and grievances.
6 ; Intake Queue, faxes, Inbox, Aspirus inbox, eAppeal in Banjo, member portal
A&G has how many people on the team?
Hint: Include Intake, Specialists, QA, Nurses, Audit Specialists and your leaders!
Which IFP plan(s) are available to only those 30 and younger?
Ucare Core and Ucare M Health Fairview Core
A State Appeal must be requested in writing within how many days of the appeal decision?
120 days and the MN Dept of Human Services Appeals Division
The timeframe to submit a C2C request is?
Expedited - 24 hours ; Standard - 48 hours
According to the recent SLA with the MD's and Pharmacy team, how many days do we allow for review if the case is due within 6-7 days before TAT?
3 days for review