General
Knowledge Management Tool
What does KMT stand for?
These type of members do not pay a penalty even if they go without creditable coverage
What is LIS?
CMS
What is Center for Medicare & Medicaid Services?
Under this plan the member can be outside the service area for a maximum of 12 months before being disenrolled
What is PPO?
Online @BCBS, paper, broker/agent, licensed sales agent.
What is ways to enroll?
Under this plan the member can be outside the service area for a maximum of 12 months before being disenrolled
What is PPO?
WHAT MONTH WOULD YOU RECEIVE A BILL FOR MARCH'S PREMIUM
What is FEBRUARY?
True Out of Pocket
What is the TrOOP?
While using this service, a member will not be required to copay or coinsurance for days 1-20
What is SNF?
Runs from 10/15 to 12/7
What is Annual Enrollment Period (AEP)?
Required for providers that file claims electronically or hospital admitting privileges or writing prescriptions
WHAT IS National Provider Identifier (NPI) ?
HOW LONG DO YOU HAVE TO DEPOSIT/CASH A REFUND CHECK
What is 6 MONTHS?
MAPD members receive one per month if a claim was processed during that month.
What is EOB? (Explanation of Benefits)
Under the PPO Enhanced plan, this stage begins when the first RX of the year is filled
What is Initial Coverage Stage?
Has to be requested in writing before desired effective date of policy.
What is Disenrollment?
THIS FORM IS USED WHEN MEMBERS WANT SOMEONE ELSE TO FILE A GRIEVANCE ON THEIR BEHALF
WHAT IS APPOINTMENT OF REPRESENTATIVE FORM?
THIS DEPARTMENT SENDS OUT THE COVERAGE GAP FORM
What is SENIOR MARKET CORRESPONDENCE TEAM?
OEPI
What is Open Enrollment Period for Institutionalized Individuals?
This procedure qualifies a member to receive one pair of eyeglasses if deemed necessary
What is Cataract Surgery?
Shows how well Medicare health and drug plans perform
What is Star Ratings?
WHAT IS THE DESIGNATED COMPANY THAT YOU REFER CURRENT MEMBERS TO WHO CALLS WITH A HRA ACCOUNT (HEALTH REINBURSEMENT ARRANGEMENT)
WHAT IS Extend Health or AON?
WHEN THE LATE LETTER IS SENT
What is letter is sent by the 15th of the month to Members who have not paid by the 9th - 12th of the month?
AVS
What is Application Viewer System?
While utilizing this benefit, additional services such as X-Rays, maintenance, and other diagnostic services will not be covered
What is Chiropractic Services?
Policies that are secondary to Original Medicare
What is Medicare Supplement?