Plan-Smart
What does it mean when the date verified is red and what steps would you take?
It means that the dependent is not yet verified. it means that documents were submitted after the deadline and failed. Check the pen and pad, scripting and alerts for claims and appeals options.
Approval for reinstatement of a dependent via a Claim/Appeal is ALWAYS a guarantee. True or False
FALSE
What is the 3 modes of submitting documents to DVS for verification?
Online Upload, Fax, Mailing
How can a CCR access the Web portal.
Via Computer App
What field must up be updated as what code to ensure the extension takes effect?
The extension is the Reason code field “Extension Granted”.
Which tabs can a snapshot box be found?
Audit Tab, Issues Tab, and Mailings Tab.
Can CCR re-send the Level 1 Claim Determination Letter through PlanSmart?
If it has been at least three business days since the determination letter was queued and the Benefits Center is not reflecting the updates; please create a ticket on the H&W side to receive the update.
What is a verification set and where in PS can I locate the VS information?
Verification Sets are the requirements set up in Plan-Smart based on the client’s Summary Plan Document. The client chooses which dependent types they will cover.
PS>Issues>Verification Requirements>Click on the i button
What are the names of the tabs in the Web portal?
a. Action
c. Active
d. Completed
When can a first extension be provided?
On the deadline date or before the deadline date
Which tab reflects the contact preference and the portal access timeframe? Which one can you make changes to?
Demographics Tab and portal access (grant access)
Do claims and appeals reinstate coverage retroactively? (Show on your tools)
No - If a Level 1 claim is approved, the dependent is reinstated retroactively.
If a Level 2 appeal is approved, the reinstatement effective date varies by participant.
The Level 2 Appeal determination letter will include the effective date of coverage
What are the document types that the review team would look for during review?
a. Proof of Marriage
b. Proof of Financial Partnership
c. Federal tax returns
Where can a dependent access their web portal and what snapshot gives you the pathway?
MyBR/AWL > dependent verification tab on the home screen or message center > DVS verification link
CCRs can CC the employee's email ID in the email request and sent the documents directly to the member - True or False?
CCRs DO NOT EMAIL THE DOCUMENTS DIRECTLY TO THE MEMBERS.
If done so, this will create a Security Violation
Name the icons you will see in a snapshot box
House (More detailed in Plan Guard), Envelope (Mailings), Folder (Documents Received) - Notice difference in the folders, Pencil and Paper/ Pen and Pad, Script Items, Computer (Portal/Website Information), Alerts
What reason code would you use for a TM Escalation if and does it require a follow up call: Employees calling to state spouse has passed away
Use One Note to modify template for TM Escalation> Death and No. (show in tools how you would create an issue for the death case)
CCRsWhat are the 3 columns under a verification set and what do they represent?
Plan-Guard Events, Accepted Sets, Alternate Docs
Explain and show in tools
What information reflects under the resources tab, and which document can be used to verify CLS?
Eligibility Documents, Common Law Spouse Affidavit, Domestic Partner Affidavit, FAQs, and access to the State/County Clerks and Foreign offices to request documents.
We can advise that this can be done via their DVS portal.
Please note this is only available during an active verification window and if the dependent has not been verified.
Explain which tabs we use in plan-smart and what they are used for:
Subscriber, Demographics, Audit, Issue, Mailings
What template would you use for Level 1 Appeal Issue Notes?
Level 1 Appeals --- Show it in One Note
What is the preferred mode and why?
Online Upload - The fastest and most reliable
Documents will be viewable for GHRSC and the Review Team within 48 hours
Documents will be reviewed within timeline: Up to 5 business days.
Where can the ppt view the mailings that was sent out to them?
Notices Tab
When creating a request to email document request please confirm the email the request is sent to, the template, and what information must be provided to the team. (Guide through the steps)
To Email Address: DG-AH-Global-DASMAIL@Alight.com, CC: DG-AH-US-BACClientSpecialists@alight.com, Subject Line: Email Document Request: Ppt Name & ID Number
Template (show in tools)