A
What is a premium?
The amount the member must pay before entering the initial coverage stage
The amount the member must pay before entering the catastrophic stage
The amount the member must pay each month for their plan
Premium benefits added to a members account
The amount the member must pay each month for their plan
Blue script in CAREConnects means?
Suggested scripting, but does not have to be verbatim
What does FTP stand for?
Failure To Pay
PWO stands for?
Premium Withhold Option
Payment Withhold Option
Payment Was Obtained
Payment Was Overdue
Premium Withhold Option
Green script in CAREConnects means?
Must be read verbatim
When is the premium posted on a members account?
7th of the previous month
15th of the previous month
20th of the previous month
Last day of the previous Month
7th of the previous month
Who does someone contact to see if they qualify for Medicare?
SSA
If a caller does not have the member ID the next best thing to try is?
Medicare ID
We can do a CD for what?
To have a new Rx reversed
To have a NF drug covered
To have a deductible lowered
All of the above
To have a NF drug covered
How does a someone get a POA form?
Anyplace you can get legal documents, such as a Courthouse, Staples, or Library
What is Part A Medicare?
Physician and hospital (outpatient)
Prescriptions Drug benefits
Advantage plans
What is Part B Medicare?
Physician and hospital (outpatient)
Prescriptions Drug benefits
Advantage plans
Physician and hospital (outpatient)
Who can do all the same things as a member on an account?
POA
What is Part C Medicare?
Physician and hospital (outpatient)
Prescriptions Drug benefits
Advantage plans
Advantage plans
What is Part D Medicare?
Physician and hospital (outpatient)
Prescriptions Drug benefits
Advantage plans
Prescriptions Drug benefits
How many days does a member have to appeal a coverage determination?
65 days
What cannot be seen in Sensentia?
Drug Tiers
Copays
Premium
Current Benefit Stage
Current Benefit Stage
You can provide alternative drugs to members only if?
The drug does not require a PA
If it shows Alternatives under notes and restrictions
It is for a brand name drug
It is from the same therapeutic class
If it shows Alternatives under notes and restrictions
To check a members current OOP amount check?
Meps
CAREConnects
Sensentia
CSP
CSP
A member has how long to request a GCR after a plan is termed for FTP?
60 days
When does a member go into FTP status?
After missing 1 payment
What 2 buttons can you press to help search an article faster in Care Connects?
CTRL + F
You must confirm the identity of?
A. People who call
B. Those who come up IVR verified
C. People you call
D. All of the above
E. A & C
D. All of the above
GCR must be started before a plan is termed for FTP?
False
A member may get a LEP if goes without prescription coverage for how long?
63 days or more