SEPs
Ms. Jones has Medicare Parts A and B. Today she received a letter saying that she now qualifies for Medicaid as well. What SEP (if any) can Ms. Jones use to enroll in an MAPD plan?
What is MCD? MCD is for Individuals who Gain, Lose or Have a Change in their Medicaid (Dual Eligible) Status.
How is "utilization" measured?
What is whether you are in the correct status or not? Things that bring down utilization are:
-Long breaks/lunches
-TMM codes (ACW, Follow Up, OBP, etc)
(Should be at least 70%)
Congrats on your enrollment! What disposition should you use?
What is "Thank You Card/Telephonic Enrollment"?
When does an agent have to START the required TPMO disclaimer?
What is within the first 60 sec (1 minute) of the call?
When leaving at the end of your shift. What must you do in I3? (Give the process)
What is log out? Out of office>File>Log off>File>Exit
Mr. Brown was enrolled into a Humana plan during AEP to help cover his dental needs. It is now January and he learns his doctor is not in network. What can we use to help Mr. Brown find a plan his doctor accepts?
What is the OEP (MA-OEP) SEP? During OEP, MA Plan members may have an opportunity from January 1 through March 31 to switch MA plans (with or without drug coverage) or to disenroll from an MA plan and obtain coverage through Original Medicare (with or without a stand-alone PDP).
How is "productivity" measured?
What is how much time your are logged into the phone system vs how much time you are actually on the phone? (Should be at least 65%)
You just received an inbound call and the client decides they are not ready to enroll just yet. What should you use to call him at a later date?
What is RPC? (Will accept AEP-OEP Call Back)
What is the MINIMUM score an agent must achieve to receive a passing QA?
What is 85%?
If a client does not have their Medicare number what information is needed to perform a MARx check? (Assuming disclaimer has been read)
What is:
-Full name
-DOB
-SSN
Ms. Jackson has been enrolled into Medicare Part A since 2016 after retiring from work. She now spends her weekends taking her grandchildren to the park. Last week she was recently diagnosed diabetic and called you for coverage to help contain costs of her condition. She heard about a "diabetic plan" from her neighbor. What SEP can you use to help her enroll in such a plan?
None. Ms. Jackson would not only have to be entitled to Medicare Part A, but must also be enrolled into Medicare B.
What is how many enrollments you have vs how many inbound (queue) calls you take?
The queues are slow and you're working your book. Your client doesn't answer. After leaving a voicemail, how should you disposition?
What is "Left VM-Unable to Contact BOB"?
When is an agent required to gain C2C?
What is within the first 5 minutes of the call?
What must you do after successfully transferring your client to the CSA?
What is Open a Teams chat with yourself, the CSA, and your manager?
Joanne is enrolled into Medicare Parts A and B. She recently retired from her job last month. What SEP (if any) can she use to enroll in an MA/MAPD plan?
What is LEC? This SEP is for individuals who are losing group health coverage (including COBRA).
What must 2 things must be done any time you open a lead?
What is:
-You must call the lead
-You must leave a note detailing why you accessed
You just received a call from the queue. Upon obtaining their zip code you realize you are not appointed in their state. What disposition should you use?
What is "Licensed Agent Call Back"?
Which carrier (if any) can someone other than the beneficiary or authorized rep/POA complete an application on the beneficiary's behalf?
What is UHC?
Which type of apps are CSA not allowed to do?
What are:
DSNP, CSNP, any carrier direct, any SEP apps?
When can you use the 5 Star SEP?
What is anytime throughout the year EXCEPT Dec 1-7. (Dec 8-Nov 30)?
What is 10 minutes?
You just finished presenting a plan to the client and they ask if they can do the application online. You reply with "Of course!" After sending your client the enrollment link, what disposition should you use?
What is "Online Enrollment Email Sent-Non BPO?"
Agent John calls his client and asks "May I speak with Denzel Washington?" Client responds with "This is he." How many more pieces of information must John verify in order to fully HIPAA verify his client?
What is 3? 3 pieces of information is required to fully verify a client. Since John called the client by their FULL NAME this can NOT be used to verify.
What is the process to transfer to a CSA? (step by step instruction)
What is "New transfer>NGIC>Sales>Benefits Advisor>HCIA Internal>Telephonic Enrollment?