Testing
The system, or software, used by EOB to validate proofs?
What is ONEsuite (2.0)?
True out-of-pocket costs paid by a beneficiary or others on the beneficiary’s behalf that accumulate towards the annual out-of-pocket threshold.
What is the TrOOP?
This testing cycle starts on week three of the month and serves as an internal review.
What is Mid-Month?
A beneficiary communication meeting the requirements specified by CMS, including the Beneficiary’s Year-to-Date True Out of Pocket (TrOOP) and Drug Spend information along with monthly claims detail and negative formulary change information (as applicable) and such other information as required by CMS.
What is an Explanation of Benefits (EOB)?
This site used to find PTO and Production dates, as well as Client Analysis sheets.
What is SharePoint?
What is the Client Approved Document?
A Medicare program to help people with limited income and resources pay Medicare prescription drug program costs, like premiums, deductibles, and coinsurance.
What is Extra Help?
This testing cycle starts on the first week of the month and includes all data from the previous month.
What is Samples?
The Company used by CVS as it's print vendor which offers electronic document delivery, web applications, digital and offset printing, automated composition, warehousing and fulfillment services.
What is O'Neil Data Systems (ODS)?
This App is used to find our most updated training materials.
What is Microsoft Teams?
Framework, PBP, Scenarios, Claim Validation
What are the four pillars of testing?
A summary of total costs accumulated through the plan or calendar year, up to the date which the EOB represents.
What is the Year-to-Date Total?
This testing cycle pulls in additional scenarios from current production data that were not seen in a Sample review.
What is Delta?
A spreadsheet containing plan-specific information provided by clients (e.g., plan name, return address, customer care hours of operation).
What is the Master Data Grid (MDG)?
A shared network folder for checking a client’s current templates and MDGs.
What is the Shea Drive?
This Excel document displays the client's distinct branding iterations per template type.
What is the Unique Report?
A pharmacy that filled prescriptions for the member, but is not in the member's plan network.
What is a Out-of-Network Pharmacy?
This testing cycle serves as one final round of validation before EOBs are mailed.
What is Production?
A unique identifier generally used to distinguish a plan’s template type and when it was approved.
What is the Material ID?
The tab in 2.0 for checking submitted problems found on proofs and their current status.
What is the Issue Log?
State-specific models that are formatted with only sections A, B, and C.
What is an MMP DUO?
A column in chart one explaining total out-of-pocket costs paid for by the member in the timeframe specified in the EOB (monthly or year-to-date).
What is the "You Paid" Column?
This testing cycle has proofs corrected by the Print Vendor and only lasts a few hours.
What are Revised Proofs?
A period of coverage in which the member pays a higher portion for prescription drugs until enough is spent to qualify for catastrophic coverage.
What is the Coverage Gap?
This tab is used to ensure the correct version of a client’s template is being used for a proof.
What is the Crosswalk?