SOP
What SOP will you use for a DSNP Member address change?
Medicare Demographic Changes Standard Operating Procedure (SOP)
7
Medicare provides coverage for what type of people?
How do you determine the cost share for medications?
LIS level
When a member asks UHC to reconsider a decision we made about approving a healthcare service or claim is known as what?
Appeal
What SOP will you follow if a DSNP member wishes to disenroll?
Global Medicare Disenrollment Requests Standard Operating Procedure (SOP)
Member Advocate
A Medicare plan that covers Prescription and can be purchased as a standalone plan?
Part D
A member's Medicaid benefit is determined by what?
Medicaid Category or QMB level
An expression of dissatisfaction with any aspect of the health plan or a provider’s service is known as what?
Grievance
What SOP will you use if a member calls in advising they received a notice that they no longer have Medicaid?
Loss of Medicaid process
If member applies for coverage today, when will his effective date be?
May 1st, 2019
A Medicare Plan that covers inpatient and skilled nursing facilities?
Part A
What tool would you use to verify the member's LIS and Medicaid level?
Marx
When a member feels that he or she has received poor service or misinformation from their insurance broker is known as what?
Broker Complaint
Which SOP will you use if a member calls in requesting an OTC catalog?
First Line Medical Health Products Benefit Catalog Job Aid
If a member calls in requesting a care coordinator, who will you refer him to?
Service Coordinator
A Medicare Plan that covers outpatient and DME benefits?
Part B
What tool will you utilize to update the member's demographics?
Maestro
A decision about a Part D benefit or payment for which the member believes they are entitled?
Coverage Determination
Which SOP will you utilize to correctly document an appeal, grievance, or determination?
Medicare Call Categorization Job Aid
Start Plus Routine Vision benefits are handled by what vendor?
Superior Vision
UHC DSNP plans are also know as what type of Medicare Plan?
Part C
What does DMEV stand for?
DSNP Member Medicaid Eligibility Verification
A decision about a Part C benefit or payment for which the member believes they are entitled?
Organization Determination