Job Aids
What job aid will help you with the MC Program codes?
Health Plan Crosswalk
If a member who is enrolled in an ACOA/MCO is calling regarding prescription coverage how would you proceed?
Refer them to their health plan
Where do you find the phone numbers for the different health plans?
Health Plan Contact Matrix
Member calling to complete a SACA application where would you transfer?
356 or 357
Can a member have a TPL and enroll in a health plan?
No
What job aid would you pull up for a member calling in to update PCP?
Changing PCP: Transfer to Member’s Health Plan or Internal Transfer to HP CSR
What is the new replacement medication for weight loss?
Wegovy
If there is no active dental row and the member has active coverage how would you proceed?
Create the Dental Task
If a CAC/NAV calls in where would you transfer them?
MA_Assister_Main
MassHealth will pay the provider directly
If you receive a MMIS Error message when enrolling a member what job aid can assist you with next steps?
MMIS Health Plan Error Messages
What is the name of the resource to check for a Prior Authorization for a medication?
MassHealth Drug List
If a member has an ACOA and need Behavioral Health services how would you proceed?
Refer them to their health plan directly
Member has Health Connector and calling to choose health plan how would you assist?
Transfer/ refer to (877) 623-6765
Will a member with an Aid Category 90 qualify for a health plan?
No
Member inquiring about a covered service for their health plan what job aid will assist you?
MassHealth Plans Covered Services Job Aid
What medication can be supplied in a 12 month supply?
Oral Contraceptive Birth Control
Who DOES qualify for a Health Plan?
Member experience domestic violence and need to add protection to their account where would you transfer them?
Transfer to 354 or 355
Can an ACOB member update their PCP during their FEP without exception?
Yes, we would just need to complete an ACOB facility update task
If you receive a MMIS Error message when enrolling a member what job aid can assist you with next steps?
MMIS Health Plan Error Messages
If there is a discrepancy with Pharmacy and MMIS what should you do?
Complete the Discrepancy between Pharmacy and MMIS task
Who DOES Not qualify for a Health Plan?
If a member enrolled in a PCCP needs to update their facility where would you transfer them?
No where we would update the Facility
What job aid is used to determine if a member is eligible to enroll in a Health plan?
MassHealth Aid Category Coverage Type Matrix