Disenrollment
What classification and Intent do you use for a disenrollment call?
Classification: Disenrollment
Intent: Info Given
What Classification and Intent do you use when processing a cancellation for a future plan?
Classification: Cancellation of Enrollment
Intent: Processed
When do you need to have Mentor pulled up?
For every call !!
What does "CI" stand for?
Customer Interface
If you are speaking directly to the member which interaction will you choose?
With & About
What is an SEP?
Special election Period- special reason or circumstance that medicare deems acceptable to make changes.
What 4 ways can mbrs send in their d/e written requests?
Which application(s) do you check first before processing cancellations?
MARX & CI
What is the link you use to get to mentor?
go/mentor
*Fill in the blank*
If you dont ____ it doesnt matter
PATR
What do you do after you create your interaction?
Authenticate and verify the member.
-Name
-DOB
-Zip code
When should you go through the SEP questionnaire?
For every d/e call!
When do plans term after we received mbrs d/e written request?
d/e date is always the last day of the month that the written request is received
Where do you go to check the Call by date and where do you get the verification ID?
EMME
CI PCRP screen
What mentor doc should you use to handle d/e calls?
Disenrollment and Cancellation Status and Guidance Calls
OR
Disenrollment and Cancellation Medicare Inbound Calls
What screen can you find the humana ID in CI?
UMID
If member states they have called in previously where would go to find the notes from that call?
Case History
Which plans is the SEP maintaining other creditable coverage valid?
PDP and MAPD
If it is during AEP and mbr DOES NOT have an SEP when will their plan end?
the plans ends on the last day of the year
What do you do when a future enrollment has a Transmit Status of 01/51?
Pend case for 3 days until transmit status is workable
What mentor doc do you need to use for a cancellation?
Medicare Plan Cancellation Calls
What button do you use to navigate through CI?
Tab
Which quicklink do you use to pull up the members coverage?
Benefits & DEBUT
Is hospice considered an SEP?
unfortunately No
Where can you find if we have received mbrs d/e written request and if its been processed?
Case History in CRM
When you process a cancellation what should you always attach in the attachments to your case?
Marx screenshot
Who should you reach out to if there is an error in mentor or it needs to be updated?
Sup or TL
After you put in the UMID what button do you press to populate the plan?
F4
What do you always get from the member before documenting?
Callback number
When can LIS be used as an sep?
*2 answers*
Outside of AEP
If LIS has not already been used for that quarter
Where do you go to see if a plan is a mass move?
go/beast
If the member is not showing in CRM, CI, or marx where do you check to see if member put in a recent application?
Fastapp
How do you know which mentor doc to pull up for certain call types?
Quickstart will show mentor docs to use on the left after you put in classification and intent.
If you get the angry man what do you do?
Press ctrl
If the call came in authenticated, do you still ask the member for their DOB and zip?
Nope! That is over authenticating
Where do you check to see if LIS has been used for that qtr?
Marx under "election type usage code"
When a member says they did not give consent to enroll into the plan and it is after the eff date what do you do?
File Sales Allegation (Section A)
Warm transfer to DECT
What do you do when member wants to be reinstated back to previous humana plan after you cancel the future plan?
Send case off to Disenrollment Correspondence team to have plan rekeyed.
If you are stuck on a step in mentor what should you do?
Reach out to someone in teams and let them know what mentor doc your in and what step you are stuck on.
When processing a cancellation what screen will that be processed on?
PACT
Where can you find if member has POA or consent on file?
Located under HIPPA forms on person account page
If a member was affected by a weather-related emergency where would check if that were still a valid sep?
Natural disasters guidance overview mentor doc
Note: this sep can be used 2 months after emergency end date.