Fulfillment
The number of contact attempts you must make before sending an Unable To Contact Letter.
What is 3?
The Intent you would use for MRC issues.
What is Enroll / Disenroll a Member?
You want to verify member's benefits for transportation.
What is Review Medical Benefits?
You submit a claims issue here.
What is Claims - COSMOS or Claims - Nice?
Every call starts in this system.
What is Maestro?
The minimum time between contact attempts.
What is 4 hours?
The Job Aid you would use for MRC issues.
What is Enroll or Disenroll a Member KM1550901?
This Intent is opened and completed for every phone call, email and interaction with a member.
What is Escalation Team Intent (ETI)?
True or False: DMR issues can be submitted to the Claims SharePoint.
What is False, use the separate DMR SharePoint?
You are unable to update member's PCP in Maestro. You can accomplish this by using:
What is GPS?
Where you would go to send an RX DMR Form to a member via postal mail.
What is Maestro - Member Materials?
Member's PCP is not INN on her new plan. Member only wants that specific PCP. Your next steps are:
What is MIOD for Continuity of Care?
Member calls to update their Method of Payment (MOP).
What is Manage Payment?
Member believes Agent lied to him about his new plan. Application shows "LEAN-Telesales". To verify, use this SharePoint.
What is Telesales Call Requests?
You can pull an Advocate/Member call here.
What is Qfiniti?
Submitting a request to CAMP?
Member would like to enroll in a different plan. To assist member with this request you will:
What is verify an SEP and warm transfer to Telesales?
Member calls to advise of her physical activity.
What is Rewards?
What is Mapping Key / Amaardi?
Here you can search for SNF PAs.
What is NaviHealth?
Where you would go to send an Medical DMR Form to a member via postal mail.
What is GPS - Write Letter?
The Job Aid you would use to help member compare new plans.
What is 2025 Plan Change Comparison Tool KM1879350 ?
Member would like his plan to cover a procedure that is currently not covered.
What is Complaints, Appeals and Grievances?
Your first step in submitting a DMR for member.
What is Backend Filming?
This system allows you to take payments for Utility Bills.
What is CRM?