Turnaround Times
What is the TAT for a Do Not Contact update in the member's account?
Up to 30 days
What is Doc360 used for?
Print, view and mail EOBs, review claims
If I wanted to get an MRI, what would be the best option to choose in Rally in the "Find Care by Category?"
Places
Is this scenario a verbal grievance or a quality of care grievance? Scenario: The vitamins Dean ordered using his OTC benefits arrived 2 weeks late, but it did not affect his health or course of care.
Standard Verbal Grievance
What are the dates that the CAHPS survey goes out?
March-June
What is the standard TAT for expedited Part B Drug requests?
24 hours
What is MARx chat used for?
Look up specific information CMS has on file for members
If Kim calls on behalf of her mother Patricia, who needs help with bathing and daily talks, what should you advise based off these benefits?
Patricia's plan doesn't cover custodial care, and you offer to refer her mother to national or local resources.
What kind of complaint, appeal, or grievance is this? A member would like to get a power wheel chair expedited as soon as possible.
Organization Determination
What does NPS stand for?
Net Promoter Score
What is the Standard TAT for all standard MIOD's?
14 days
What is PCSS used for?
Scheduling HouseCalls
If someone is interested in a HouseCalls visit, what would you tell them is included?
45 to 60 minute visit with a healthcare practitioner, review of the member's health history and medication, complete head to toe exam and health screenings to monitor the member's well-being.
Is this a quality of care (QOC) or standard verbal grievance? A member saw their PCP and her PCP fell asleep while giving the member stitches.
QOC
Medicare beneficiaries are entitled to receive one of these visits with one PCP or specialist per calendar year.
Annual Wellness Visit
What is the standard TAT for Part B Drug Requests and all other expedited requests?
72 hours
What is VIEW used for?
Look up billing and enrollment documentation sent to UHC.
If a member wants to know her copay for cataract surgery (an outpatient surgery), what drop down should you choose in the Review Medical Benefit intent?
Inpatient/Outpatient
What is the definition of a Coverage Determination?
If the member believes the health plan has charged a different cost-sharing amount than the person thinks he or she should have to pay.
Example: disputes about the copayment amount.
Which one of these is a wellness benefit?
Fitness
Vision
Dental
All of the above.
What is the TAT for HouseCalls rewards to be loaded to the UCard?
7 Business Days upon completion of the HouseCalls visit.
On which tab of Review Medical Benefits can you see if a member's deductible has been met?
Plan Level Liabilities
What is the website called to locate Behavioral Health providers?
Live and Work Well
What is an example of CMS issues when it comes to Complaints, Appeals and Grievances?
When documenting in Maestro what 5 things do you need to ensure that you have when documenting?
5 W's:
Who
What
Where
When
Why
How