SYSTEM
what system is used for Manual Medicaid check
state portal
True or False: Disabled members DO NOT have to renew their medicaid.
False
What is the purpose of CMS in relation to Medicare members?
CMS is utilized to assess whether a member has Part A/B coverage and Low-Income Subsidy (LIS) qualification.
What is the common name for LIS
extra help
What is the mandatory hotline that employees are required to use for reporting their attendance in the call center?
Must Call Attendance Hotline
where should all discussions with agents be recorded?
Call tracker
A member's eligibility is determined by what?
Medicaid level
How many verifiers do you need for HIPAA to verify recipients?
3
Required Medicare Eligibility includes?
First and last name, Medicare # or ssn, DOB and State.
What are the stipulated regulations regarding transferring calls without prior notification?
No cold transfers are allowed
What does the term MELA represent?
Medicaid Elligibility level application
These are the three minimum requirements to enroll in a DSNP.
Qualifying Medicaid level, part a/b, & lives in the plan's area
This Carrier requires that a DE Verification code be placed on the Enrollment application submitted for any of their DSNP plans.
"Anthem"
HIPAA stands for what?
health insurance portability and accountability act
To whom and what, must be provided in case of an outage, or system issues that could possibly delay your work shift or duties?
All screenshots supporting reports of possible outage or issues must be promptly reported to the supervisor.
What is the alternative software employed to generate a DSNP code when MELA is nonfunctional?
Salesforce
True or False: To remain enrolled in Medicaid, members must go through an annual renewal process
true
What's WDIG?
Where do issues go?
what component must a member have in their Medicare, to be deemed eligible?
part A/B
what system to use to receive call?
five9
what excel sheet we can use to check medicaid eligibility
reference guide
This is the time of year is where the Dual/LIS SEP cannot be used.What is the fourth quarter of the year? (October through December)
AEP
If a Member does not speak English, what resource should be used to complete the call with the Member?
Language Line
the Centers for Medicare & Medicaid Services, is known as?
CMS
How should reps handle incoming calls to ensure compliance with the call center rules?
No call avoidance; all calls should be address appropriately