GCNJ
Provide 3 things you should review when consumer says they lost their APTCs
Is the consumer Medicaid Eligible?
Confirm response to Help Paying for Coverage Window
Has your income or tax household changed recently?
Do you have a multi-person household?
Have you filed your <fill in previous year> taxes? (reconciled)
Consumer disagreed with the Renewal and verification acknowledgment at the end of the application
Have you fulfilled all DMIs for the current year
If you are unable to click validate & link, what should you do?
Click Cancel next to Search in the Case/Consumer search section.
Re-enter the callers information in the Case/Consumer search section.
Repeat steps previously taken.
Click Validate & Link
If this DOES NOT work, THEN you add to CP outage form
What is a Data Matching Issue?
If the information in a consumer's application doesn't match information from our trusted sources (IRS, SSA, DHS, ETC), we may need proof to confirm the consumer's information.
-- The consumer will have roughly 155 days days to provide proof
-- If the consumer does not provide acceptable documentation, they may lose their coverage and/or financial help
Total income is the income of everyone in the tax household with a tax filing requirement, including any dependents who are required to file taxes
What is the #1 Cosmetic company in the world?
L'Oreal
Where is the Policy ID number located? (cause yall keep using the wrong one)
The Policy number is the one that says "Exchange Assigned Policy ID" when looking at the Enrollments from the CAP screen
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Account member calls who is NOT the primary, what can they do?
What Cant they do?
They can receive information that pertains only to their part of the account and/or information regarding their own enrollment.
If the account member is not on the line with the Primary Contact (HOH) on the account, the account member may not receive any other information regarding the account.
They CAN NOT
Add or remove a member
Update an application
Change plans
Add an authorized representative or 3rd party caller to the account
What are all the ways a consumer can complete an application?
BY THEMSELVES on line
With you over the phone
BROKER
What is Jo Jo's Dog Name
What kind of dog is it?
Cutest, Baddest Frenchie in the World
Who was the most famous person in the world?
Michael Jackson
But I will take Mickey Mouse too
Ticket History
Manage Members
Ticket History
Select the Ticket ID
What info is required for a Backdate subsidy Request Task?
Request for Subsidy Backdate.
Primary member's full name
List all members who are enrolled
Policy #:
Requested Date:
Reason for Backdate:
Name of Caller
Details on the request
Who is in the TAX Household?
Spouse if filing jointly
Anyone included on the tax return as a tax dependent
How do you correctly enter OT on your timecard?
Enter hours for each day exactly as worked
Once you get to 40 Regular hours
Enter the additional time on the OT line
Who is the richest Female singer in the world
Taylor Swift
What do you review in GCNJ when the consumer request a reinstatement for their policy ?
Click Enrollments.
Review Enrollment Status.
Click Additional Information.
Navigate to Enrollment History.
Review Event and Maintenance Reason to confirm termination and reason.
Confirm reason for termination.
Click Applications.
Review Application Status
Review Event(s) and Date(s)
Does the consumer has a Reasonable Opportunity Period Expiration (DMI ROP)?
What must you verify with a consumer?
What must you verify with a broker?
You must verify DOB & SSN if consumer did not use the IVR. You must verify address or phone number if consumer used the IVR
Broker - You must verify the broker's NPN and certification status. If the broker is calling for a consumer, they must provide verifiers for the consumer.
How do you check the status of a CP task
You have already authenticated the consumer and validated and linked the account. Click on task & service request and the task will populate. Click on the task and scroll down to the notes. If updates are needed. Click on Edit task in the top right corner add the updates and click save.
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To check notes or task for a third party BNA- Contact record search /type in the BNA first and last name and click search.
What is the highest grossing animated movie of all time?
Inside Out 2
Yall thought it was Lion King didnt you
Where can you locate the Medicaid Denial?
If you can not locate what must you do?
1. Locate the consumers account in GCNJ and remain in CSR/CAP View
2. On the left hand side, click on Account Activity
3. Locate and expand the entry Eligibility Information- Medicaid Eligibility Received 4. Find the rejection code
5. Confirm the rejected member(s). What do these denial codes mean? 143 Consumer was denied due to Ineligible Immigration Status. 144 Consumer was denied due to being over the income . Admin Denial - Consumer failed to provide requested information
If unable to locate in account activity you must reach out to NJFC and document the reason and person you spoke with.
What info is needed for a Medicare Retro Disenroll request task.
Request for Enrollment Cancellation.
Primary member's full name
List all members who are dis-enrolling
Policy #:
Requested Date:
Are there any claims against the GCNJ coverage?
Medicare/Medicaid/CHIP (NJFC) coverage start date:
Plan (Managed Care Organization) start date:
Has the consumer been made aware Medicaid may not cover claims occurred prior to the start date of the plan (Managed Care Organization)?
Phone Number:
Best Time to Contact:
Name of Caller
Details about the request
READ THE SCRIPT VERBATIM
Where do you find Medicaid denial codes in Panviva?
Research Guide
Task 12
When do we need to resend an 834 File
Do we have to speak with anyone other than the consumer to send?
If consumer's GCNJ enrollment info does NOT match carriers info
Yes, we must speak with the carrier
After speaking with the carrier we can add to sup tracker
What animal (dont get technical on me) can NOT stick its tongue out
Crocodile