Cancellation
TRUE!
True or False: 1-800-Medicare is always referenced.
FALSE!
TRUE OR FALSE: 51 is workable
FALSE
METs for Cancellation of Enrollment for OSB Plan?
NONE, you do not create METs for OSB plans.
How can you identify a Comp Benefit Plan.
The Member ID Will begin with "0"
The Group Name should include "Individual Group of ____"
Why do we pend Cases?
Pend for Cancellation to Process
Pend for Reinstatement of the previous Plan
Pend for Transmit Status to Update
Pend for an Unknown Member Plan to Show.
Classification and intent when a request was already processed and info is given on a linked case.
Disenrollment/Duplicate.
38 is Potential Disenrollment.
False, is Cancellation of Enrollment
Task for Cancel Cancellation
No Mets are needed.
TRUE OR FALSE, for OSB plan, an election period is needed.
FALSE.
If the transmit status is 01/51 can I process the cancellation?
False. Pend the case up to 3 days. If the transmit status does not update after 4 days, transfer the CRM case to the ancillary team.
Criteria for a member to be eligible for a DE?
Written request from the member or POA.
A valid election period.
After the effective date of the plan.
What is the purpose of the transmit status codes for calls.
Identifies if it the case is workable or not workable to process cancellations.
This task is used when you've processed the cancellation of enrollment.
The quick MET Processing C/E Verbally in the MET Entries Association field must be selected for automatic MET Entires.
If manual entry is needed,
a. Task: Request Received
Action: Completed
Source: Inbound Call from Member
b. Task: Update Humana Systems
Action: Completed
Source: CI
c. Task: Closing Task
Action: All Updates Completed
Source: Humana Representative
If the mbr is calling after 10:00Pm for a cancellation, what will be the process?
a. Tell the caller: I'm so sorry to hear that you want to end your coverage with us. We appreciate you being our member.
b. Determine the reason member no loger wants their coverage
c. Tell the caller: Your OSB coverage has been sent to cancel the coverage. The member receives a confirmation letter in 7-14 business days.
d. Select the applicable C&Is.
e. Transfer the case to the ancillary team.
What is the process if the member wants to keep the current plan and wants to cancel the future plan.
Make the cancellation process and transfer the case to the ancillary team with the script of "Member has request to cancellation of plan (contract/PBP/segments) and needs to be reinstated back onto the precious Humana coverage. Sending to the Disenrollment Correspondence team to have plan keyed."
What are the methods you will provide to the member if it is the last 4 days of the month?
If you are processing a cancellation of enrollment and I have a Transmit status code 02, what will be the transmit status code after processing the cancellation?
47
Cancellation of DE for Transmit Status 02 only
a. Task: Request Received
Actions: Complete
Source: Inbound Call from Member
b. Task: Confirmation of Cancellation Letter Sent
Actions: Completed
Source: Letter Systems
c. Task: Closing Task
Action: All Updates Complted
Source: Humana Representative
How can I identify if the member has an OSB plan?
CRM: You will see an additional active plan.
CI: PAPI: on the right of the PAPI screen you will find OSB with either a Y(yes) or N(no).
POSB: The POSB screen is where you will confirm the OSB, the OSB type, and the OSB effective date.
MARx: You will not see OSB plans in MARx.
If the plan is showing active in MARx and on CI has the transmit status of 02/52 what will be your next steps?
1.Update the MET Enrollment section.
2. Create a work task on PATR.
3. Go to PAPI.
4.Access the PACT.
5. Update the transmission fields; Proposed End Reas, Proposed End Reas, Proposed ETC: X. Press F11.
6. Update CTR; Tracking Source ID, Tracking ID, Press F2.
7. Verify the Transmit Stat is 47 on the PAIG.
8. Access PCCV and make the changes if needed.
If the member wants to write their own request, what is the information the written request needs to be included.
Member's name, Member's ID, intent to disenroll, reason for disenrollment, plan type (HMO, LPPO, PDP), member or valid POA signature, requested disenrollment date, applicable election perdio.
Example: I ____ (UMID)wish to disenroll from my HMO effective 10/31/2099 due to having employer coverage. Signed, _____
What does Code 32 means?
Cancellation of Disenrollment Accepted-Workable
MET's for Disenrollment/info given is used when sending the DE Form Letter MA/MAPD (ME2805) Spanish.
a. Task: Disenrollment SEP letter needed
Actions: Disenrollment SEP Letter generated
Source: Letter Automation.
b. Task: Spanish letter needed
Action: Spanish letter generated
Source: Letter Automation
c. Task: Request Denied
Action: CMS Guidelines
Source: Humana Representative
How will you Identify Riders?
1. Dental Riders appear in CRM, vision and fitness riders do not.
2. Ri8ders do NOT appear on the POSB screen.
3. If it is not Comp Benefit and not on the POSB screen, it is a Rider.