ID Card and Fulfillment
It is requested to place orders for wellness products
Over the Counter (OTC) form
What is a Smart Summary?
It is a monthly, personal health finance and benefits statement that includes a member's medical and/or prescription drug claim information. It is sent to all Medicare members with the information specific to their plan.
What are Demographics?
Demographics are specific attributes that identify a member's identity
What tool should you use to locate participating providers?
The primary tool is called Find Care
Are P.O. BOX allowed for Residential Address?
No, P.O. Box only allowed for temporary address
It is used to order paper copies of benefit information such as handbooks and welcome kits.
Order Management System (OMS)
What would be an example for VAT Campaigns?
CenterWell Pharmacy Refill Reminder
Humana Medicare Automated Payment Options Program
Gaps in Care (Flu Shot, mammogram, Cologuard, etc).
How often Demographics need to be verify?
Demographics need to be verified every 90 days. The information that's verified includes:
What is PAAG used for?
The Provider at a Glance application is a back-up tool only used to resolve disputes over a doctor's network status.
Where can you confirm if the member already has a PCP on file?
CRM PCP page
If a member doesn't have their ID number, can we suggest them to view it through the website even if they have never used it before?
They will need their ID number to register on the website, so they will not be able to view their ID number there.
What does VAT Phone Calls mean?
outbound Voice Automated Technology (VAT)
Can you add or change the date of death on the member's account?
No, only the Social Security Administration office can make date of death changes. If a caller notifies us of a death, requests a corrected date, or states a death was reported in error, we can only confirm what CMS has on file. If a change is needed, callers are referred to the SSA office to report it.
What are the ways to acces to Find Care?
Current year: CRM Find Care link
Future year: www.careplushealthplans.com/physician-finder
According to the SmartSummary Statement Reprint Request Overview guideline, can members obtain updated versions of their statement?
No, only updated versions are available on Careplus healthplans.com
Three plan identifiers are used to pinpoint the item to order in OMS, they include the:
Careplus corresponds with members through various letters and forms generated by the fulfillment system called
Enterprise Measurable Messaging Ecosystem or EMME
occurs when a member intends to return to their primary place of residence.
Temporary Address Change
What should you do if PAAG shows the requested provider is out of network?
Help the member find another doctor that is in-network
If a member is calling to make an address change OSA (Outside the service area) we should inform them
if/when their Careplus plan will terminate because they moved OSA (Outside the service area)
What do you need to verify before requesting an ID Card?
The member's mailing address and PCP/PCD information
________ is a complete audio substitute for print material and is specifically designed for use by people with blindness, impaired vision, and dyslexia
Digital accessible information (Daisy)
If a member is calling to advise of a Residential Address change, we should let them know to advise ______ as well or they might be disenrolled from their plan.
Social Security Administration
Once you find a provider that suits a member’s needs, using Find Care or PAAG (when needed), complete your Case documentation in CRM. The combination Classification and Intent selected for this call type is
Classification: Provider
Intent: Locate
If a member gives a current move date and there is no Careplus plan available in the new service area, member should?
the member must make a plan change