Authentication/Interaction
If CRM shows Authenticated in green we are able to just start providing info to the mbr
In correct we must confirm the name of the person we are speaking to first. If its the same on the account that came in then you start providing info
A mbr with HS205 HMO plan can see specialists and get only 25% discount off specialist service
Incorrect they are covered for specialist and will pay their assigned co[pay for the specialist service
PPO policies have Diagnostic services listed as a Service category to choose from in benefits search in CRM
NO, the options to choose from include: Preventive Basic, Major, sometimes Orthodontics.
What should you do if you get a mbr with a policy indicating Group name Humana Inc is?
Transfer to Home office
If a member with DEN 887 calls in and you see Annual Max $0 what will you advise the mbr about it?
Advise the mbr that they have no annual Max they just have to the services according to the frequency limitation for each covered service
Someone with PHI consent can change the mbr address without the mbr verbal consent
In correct they cant only someone with POA on file can make demographic changes without the mbr
When reading the benefits in CRM which service category would you find the coverage for Deep Cleanings under
Periodontics
If there is a rider saying Prosthodontics should be covered at the basic percentage, what percentage would you advise the mbr dentures are covered at
80%
Name the mentor Document you would use to find the turnaround time for different processes
Turnaround Time Expectation
To access ID card management you click the dental policy first then go to ID card management the we are able to send it by mail to the mbrs
Incorrect we have to access the medical mbr ID then then we access ID card center to view the card but we are not able to send Medicare ID card
If a member has a case number, what is the name of the search you can use to find that case and confirm what happened one that case
Global Search
Which Lin in CRM would you click to confirm if a mbr is Assigned or not
Click PCP/PCD
H1X plans are State specific
True
If dentist finder is not working in CRM/CRM is not working at all . where else can you pull dentist finder and what are the steps to get there
Hover over shop for plans->Click find a dentist->find a dentist again-> filter in the zip code , plan type and network
Name Three places you can uncover what dental code means
Medicare Slick, The CDT book and filtering under codes in mentor
If the mbrs wife is calling for her husbands policy and she is not on the in plan how would you create the interaction. (THE CALL IS UNAUTHENTICATED IN RED)
Enter the wife's name in interaction log-> then click interacting about beside the mbrs name-> check the Authenticated box -> then click the mbrs name
When providing benefits if a code is not provided you must?
Educate the mbr on why you cant give a one specific co-pay amount and provide a range
When searching for a list of dentist manually FOR A smart CHOICE PLAN, what network would you select after selecting policy type PPO
PPO/Traditional Preferred
When you send a list of dentists by email, list all the things you must do and advise the mbr
Offer to stay on the line to make sure the mbr received the email
Tell the mbr to check Junk and Spam
Tell them it will take 3-5 mins/few minutes
Advise to ignore the foreign language in the body of the email and click the pdf file at the top or bottom
Where would you transfer a Mbr if they wanted to add their children to their plan
You would not transfer, instead advise the mbr that Medicare plan do not allow them to add dependents
When transferring a mbr to another department you can just send them over
Incorrect. You must warm transfer by telling the other agent all the info for the mbr, advise what they are calling for then connect the mbr
A mbr with a CC205 Plan would like to have her daughter assigned to a pediatric dentist what would you advise
Advise the mbr that her daughter can only be assigned to a general dentist and that her plan doesn't cover specialist. They can only get a 25 % discount off
How can i find info on how long a mbr has to submit a claim?
In Crm->Benefits Search-> General Services-->Proof of Loss.
A mbr with DEN110 called in saying she got a list of dentists however when she called they do not accept her dental HMO. How ill you help this mbr
Educate the mbr that her Medicare dental is a PPO and do MOM by calling a few offices to ensure they accept her Medicare PPO then give her those names
Mbr calling about their DEN # 118 benefits that they had in 2019 which slick would you sue to assist
The 2019 Medicare dental slick