Payment Basics
What is the Billing Clerk Code for Public Exchange plans?
A. C73
B. G02
C. X00
B. G02
Which search methods are considered best practice when locating a member in One Inc.?
Health ID, Group Number (when applicable), or Medicare Advantage Member ID.
ID-based searches are preferred because they are more accurate and reduce the chance of selecting the wrong member record. Name searches should not be the primary search method.
What information does the caller enter while in SecureMode?
The credit card number and security code (CVV).
The caller enters sensitive card information directly. The CCS should never ask for, enter, hear, or see the complete credit card number.
What identifier should be used as the best practice when accessing a Medicare Advantage member's information in CRM and One Inc.?
The member's 7-digit Medicare Advantage ID number.
Before accessing the M3P/WIPRO Portal, what information must be obtained from RAPP first?
The member's Medicare Beneficiary Identifier (MBI).
The MBI is required to access the member's information within the WIPRO portal.
Before assisting a policyholder with payment-related questions, which information should be collected to fully HIPAA verify the member?
Member's name, policy number, and member's date of birth.
Full HIPAA verification protects member information and is required before releasing policy-specific details.
A member has Autopay enabled but wants to make an additional scheduled payment next month. Will scheduling a payment stop the existing Autopay?
No. The scheduled payment and Autopay will both process independently.
Scheduling a future payment does not replace or cancel Autopay. Both transactions may occur, so always review upcoming payments to prevent unintended duplicate drafts.
While in SecureMode, the caller enters an incorrect card number. What should you do?
Use the Reset button next to the Card Number field and have the caller re-enter the information while remaining in SecureMode
A new Medicare Advantage non-group member asks if they can pay their premium with a credit card. How should you respond?
Medicare Advantage non-group members cannot pay premiums with a credit card. Accepted payment types include SSA withholding, autopay from checking/savings, one-time payments or scheduling or mailing a check.
A caller reaches the Payment Line through the Operator queue and asks for the direct phone number of a Medical Mutual Executive. What should you do?
Locate the executive and warm transfer the caller to the Executive Assistant assigned to the exec, but DO NOT provide the direct phone number to the caller.
Employee contact information is protected. Callers may be transferred or sent to voicemail, but direct contact numbers should not be disclosed.
What system is used to view the most up-to-date billing and payment information for X00 plans?
X00 is the billing clerk code for Medicare Supplement plans which can be viewed in MESL.
BONUS 100 points: what is the code or path to view billing information for Med Supp plans in MESL?
A member requests that Autopay be removed and wants the saved bank account deleted. What is the correct order of actions?
1. Turn OFF Autopay from the Dashboard
2. Delete the saved payment method if requested.
Deleting the account first may allow a pending Autopay draft to continue processing. Always disable Autopay before removing the payment method.
A member with a saved credit card calls only to update the card's expiration date. What steps do you take?
1. Verify if Autopay is turned on, if so, turn it off.
2. Use Sycurio to add new credit card.
3. Delete the saved credit card.
4. Turn on autopay using the new card.
Expiration dates and card information cannot be updated through Edit. The Edit function only allows changes to the nickname or preferred designation.
A member recently received Extra Help (LIS) approval and says their invoice still reflects the higher premium amount. What should you tell them?
Medical Mutual may take up to 30 days to reflect LIS changes. You should review the LIS rider letter in OnBase and may accept a reduced or partial payment while the adjustment is processed.
A WEX representative wants to make a premium payment using a Discover credit card for a Medicare Advantage member. Should you process the payment?
No. Medicare plans DO NOT accept credit cards as a valid form of payment.
Medicare Advantage and Medicare Supplement plans are not eligible for credit card premium payments, including WEX transactions.
A member calls on the 5th of the month, owes a past-due premium that was due on the 1st, and wants to set up autopay. What actions should you take?
Process a one-time payment for the current past-due balance, then set up autopay for future premiums.
During a one-time payment, after selecting the payment amount, payment date, and payment method, what must be done immediately before clicking the Process Payment button?
Read the confirmation statement to the caller and obtain verbal authorization.
The confirmation statement serves as the member's recorded authorization for the payment. Skipping this step creates a compliance risk and violates the process.
A caller begins reading their credit card number aloud. What steps do you take?
1. Immediately stop the caller.
2. Notify paymentsupport@medmutual.com so the information can be removed from the recording
3. Complete the PCI Self-Reporting process on the Request IT Services page.
A member enrolled in a $0 premium MA plan receives a monthly invoice for $52. After reviewing Page 2 of the invoice, you see a Vision/Dental Premium. What is the most likely explanation?
The member enrolled in the Optional Supplemental Benefits (OSB) package, which carries an additional monthly premium.
A List Bill customer calls to make a payment and provides only a group number. After locating the account in CRM, what must you do before searching in One Inc.?
Convert the last three digits of the group number to "100," identify the business name, then search for the business in One Inc.
An On-Exchange (G02) member with a subsidy misses premium payments for three months. At the end of the 90-day grace period, what happens if the account is not paid in full?
The policy is canceled. Members must pay the full balance due within the 90-day grace period to maintain coverage.
A member calls 24 hours before their scheduled Autopay date and reports a fraudulent bank account on file. They want the account removed immediately so the payment does not process. What should you do?
1. Inform the member that you will remove the account but due to timing of less than 48 hours, the account may still draft the payment.
2.Turn off Autopay immediately,
3. Delete the saved payment method,
4. Contact the Payment Line TS
You activate SecureMode, but the caller becomes distracted and more than five minutes pass without entering their card information. What should you do?
Close the Sycurio window, re-open the Add Credit Card screen, reactivate SecureMode, and have the caller enter the information again.
A member says, "I requested Social Security withholding 30 days ago, called back, and now I'm being told nobody can find the request. This is unacceptable, and I shouldn't have to keep calling!" How should this call be classified?
This is a Grievance and should be escalated according to the Medicare Advantage grievance process.
An OPERS retiree calls asking why Via Benefits has not paid their monthly Medical Mutual invoice. How should you respond?
Explain that Via Benefits does not pay Medical Mutual directly. The retiree must pay Medical Mutual first, then seek reimbursement through Via Benefits if eligible.
Via Benefits administers the HRA process, but the member remains responsible for paying Medical Mutual directly and on time.