Medicaid
What 4 levels of Medicaid cover cost share
01, 02, 04, and 08
What are the original parts of Medicare?
Part A and Part B
What does OTC stand for?
Over the counter
What intent would you use to quote plan benefits? (vision, dental, medical)
Review Medical Benefits
What benefit would you search for the members monthly credits/food/utility allowance?
OTC- Over the counter
What levels of Medicaid do not cover cost share?
03 ,05 and 06
What does Medicare Part A cover?
Inpatient hospital, SNF, some home health services and hospice care.
What are the general items that can be covered under this benefit?
Over the counter items
Healthy food items
Qualifying utility bills
Which intent would you use to file a grievance?
CAG- Complaints, appeals, and grievance intent
What benefit would a wheelchair fall under?
DME - Durable Medical Equipment
In which KC can you find the numbers to state Medicaid depts?
State Assistance Locator KM1225807
What does Medicare part B cover?
Physician visits, outpatient services, and some home health services.
What are reasons the OTC amount changes?
ANOC- Annual notice of change (yearly plan notice of change)
A plan change
Which intent would you use to change a primary care physician?
Search and assign provider intent
What is the name of the benefit for a "life alert system" ?
PERS- Personal emergency response system
What KC would you use for a member who has lost Medicaid?
Loss of Medicaid KM1273508
What KC can you find who the primary payer will be?
Medical Co-ordination of Benefits Index KM1005263
Which calls do we assist with for OTC?
Which intent would be used to verify a "bill the member received" (to see if we received the claim)?
Review Medical claim History Intent
What is the benefit for a member who would like meal delivery AFTER an INPATIENT hospital stay?
Meals Benefit - Post Discharge KM1028307
Where can we check Medicaid levels?
Maestro, DMEVS, and Marx
What are the appropriate referrals to Medicare?
CMS Publications
1095 B Tax Forms
Invalid Express Scripts Enrollment
Hospice
KM1007812 Appropriate referrals to Medicare
In which KC can you find the information needed for all OTC calls?
Where would you be able to pull a vision vendor or dental vendors name and link to in network providers?
Review medical benefits intent
What is the KC for how to quote medical benefits for dual plans?
KM1004158 Quoting General Medical Benefits for Dual Eligible Members