GPS
SYSTEMS
ENROLLMENT
MISC
BONUS
100

What does GPS stand for

Guided Personal Service

100

Name a system we use to view documents Mbrs send to us by mail or fax

IOP/ECHS & CWAS

100

How old does a MB have to be to get Medicare

65 or under 65 with Certain Disabilities or ESRD

100

What resource other than GPS Knowledge Articles do we use for policies and procedures?

E.Policies 

100

When validating a members account, what do you select for case origin?

Phone Inbound

200

Before exiting GPS what two things must you do first

Complete SR and put a comment

200

How to find what Broker is listed on members account?

Search Market Prom to get NPN/TIN and them use Broker QuickBase to get name

200

When is IEP and how long do they have

3 months before their 65th birthday, month of their birthday, and 3 months after their 65th birthday/ totaling 7 months

200

Where can you find links to many different systems you would use in one convenient place?

NextGen Wikitool

200

What is LEP and where does that charge come from?

Late Enrollment Penalty/ Medicare assesses for going longer than 63 days with no Rx coverage

300

Where do you find Medicare ID # and effective dates

Medicare Attributes

300

What system do we use to mail disenrollment form to MB?

OBC

300

Charlie Crunchy is dissatisfied with his plan and wants a new one but he used his SEP to move into this new plan last month. What do you tell the MB? The date is 11/8/24. Be specific if there is an election period they can use.

Provide empathy, advise of AEP timeframe, transfer to Telesales to help get them into a new plan.

300

What company is considered a Joint Venture with Aetna

Allina Health

300

What is the difference between warm and cold transfers?

A warm transfer ensures a smooth call transfer between the initial agent and the receiving agent, complete with introductions and context, while a cold transfer is when the initial agent transfers the customer to another agent without warning or any type of introduction involved. 

 

  

400

Can you help someone who is not a MB and not authorized on the account 

Yes, you can give level 1 information 

400

How do we find EOC not using GPS

Stars Central Portal or Aetna.com/Medicare.html

400

Strawberry Shortcake calls in furious because she didn't know she was being enrolled into the plan when she was talking to an Agent/Broker over the phone and wants to cancel her enrollment. You see that she receives extra help (LIS) Her plan began: 05/22/24, the date is 07/15/24 of her ph call. How can you help her?

Provide empathy, advise MB options to disenroll, file a grievance for MB misrepresentation or member can use SEP for LIS

400

What resource can you refer members if they do not have certain benefits on their plan that they want access too

Resources for Living

400

Jelly Fish calls to say they do not want to have their Aetna insurance anymore. What do you do? Enrollment begins: 03/01/24, the date is 02/27/24

Provide empathy and offer to cancel plan to prevent plan from starting.

500

What is needed to authorize HIPAA without being fully validated when call comes through?

Name, Mbr ID, & DOB 

(if one is missing, you can replace with address)

500

Laura Loopy is a new member and is not pulling up in GPS with her name, DOB, etc. She doesn't have her member ID. What can you do to try and find her enrollment?

Check Market Prom or Marx using her MBI

500

Luna Starlight just moved from Alaska to Texas and wants to change her plan. What election period can she use to change her plan? The date is 08/30/2024 

SEP for address change OOA this will give her 2 months to find another plan.

500

What resource can you offer to members that provides discounts of different benefits such as:

Weight Management, Hearing and Vision discounts, Oral health discount program & LifeMart Shopping website?


Value Added Items and Services (VAIS)

500

Willow Chompers is wanting know if he can add more dental coverage to his plan, where would we be able to see if this is an option?

We would check STARS to see if there is an OSB option and Willow can add it during AEP for the next year or within the first 30 days of his plan starting.

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