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100
Glucose control solutions, lancets, and insulin used with a pump are covered under which part of Medicare?
Part B
100
A member calls in and he has reached Catastophic Coverage. He wants to know when he will be out of this benefit level. What do you advise him?
Advise the member that he will remain in this benefit level until the end of the plan year.
100
A member needs help accessing her account online. Which category and intent will you use to document the call?
General> General Service Request
100
The health plan that pays first is called
Primary payer
100
Helps save on some of the most common drugs at select pharmacies
Pharmacy Saver Program
200
A member received a vaccine at the pharmacy. The pharmacy processed the claim, but the copay was higher than it should have been. What do you do?
Call the pharmacy to see if they can reprocess, if not, follow the DMR process.
200
When updating a member's permanant address, what must you advise them?
Contact SS to advise them of the address change to avoid discrepancies in coverage.
200
While using Passport benefits, what is the longest amount of time a member can be outside of plan's service area?
9 months
200
When quoting benefits, you must provide these to avoid a WAPMO.
In and Out of Network benefits
200
What does WAPMO stand for and why would an agent recieve one.
Wrong Answer Per Million Oppotunity Giving wrong or incomplete information
300
What are the four qualities of an active listener?
Attentiveness, Objectivity, Patience, Empathy
300
Use this system to find Prior Authorizations for prescriptions
RxClaims
300
A prescription that moves through more than one benefit level is called what?
Crossover Claim
300
When does the Coverage Gap end for a member?
When TrOOP is met or Plan year ends
300
What intent would I use to update a member's LIS level?
Update member LIS
400
Offers discounts on drugs not covered under Part D
Drug Discount Card Program
400
What category would you go to when managing a rider?
Plan
400
A member calls in about his pcp changing practices. He states that pcp will no longer be contracted with UHC/AARP. The member is requesting we contract this pcp. What will you initiate?
Organization Determination (OD)
400
This auxiliary person can make changes to a member's account and request any information.
Power of Attorney (POA)
400
Provides coverage for specific medications if income requirements are met
Drug Manufacturer Assistance Program
500
A member calls in to see what tier a specific medication is on. After you investigate, you tell the member the medication is non formulary. The member does not argue or request the medication be covered. What do you advise the member?
Advise the member to speak with PCP regarding formulary alternatives.
500
A member calls in expressing dissatisfaction with a sales rep she spoke with. She states the rep lied to her about what medications were covered. The member states that she will, however, stay on the plan. What two actions do you take for the member?
Document Sales Grievance & Complete the Broker/Agent Investigation Referral on the Broker Referral Database
500
Alcohol swabs, injection devices, and insulin not used with a pump are covered under which part of Medicare?
Part D
500
I need a vaccine for shingles. What is this vaccine called and what part of Medicare does this fall under?
Zostavax and Part D
500
When a member has more than one health plan, what do we do to ensure provider's are not excessively paid
COB (Coordination of Benefits)
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