Systems
I am a 3rd party vendor that plays a key role in unresolved major issues like communication, payments and enrollment.
What is Softheon?
Prior to submitting a Softheon request related to this, you must first:
Check validity, look for a credit, and follow the 9-day rule.
What is a refund request?
Use this ticketing system to send issues to Optum.
What is JIRA?
Members coverage start date needs to move later than current start date.
What is Forward Retro?
What is: Check the "3rd Party Attention" box to get this escalated to a Team Lead or Supervisor's attention.
I am an onDemand tool embedded into MicroSoft Teams, available and ready to answer any questions you may have. I use a Knowledge Base Library to locate the answers and save you time sifting through information.
What is MAHC Tier 2 Infobot?
When submitting a Softheon request, you must always protect a members BLANK?
What is Personal Identifiable Information (PII) and Protected Health Information (PHI)?
My acronym is PIM.
What is Project Issue Management?
Previously called Failed retro: members coverage start date needs to be moved earlier than current start date.
What is Backwards Retro?
When the member’s coverage or plan information needs to be modified and it cannot be done in one transaction. Member is seeking a retro enrollment date with a plan but needs to have current coverage voided before the retro enrollment date can be processed.
What is Complex Retro Enrollment
I submit enrollment files to the carrier to effectuate the member's coverage.
What is the Electronic Data Interchange?
AKA - EDI
I am 3 major issues commonly escalated via Softheon Service Request
What is Communications, payments and enrollments?
You can locate templates and other related documents by using either of these resources when entering a JIRA ticket to Optum.
What is the MAHC Tier 2 Infobot or Knowledge Owl?
Request is created if the member’s coverage start date needs to be changed.
What is Retro Request?
I should always refer to these 4 resource when handing enrollment date changes.
What are:
SOP 147 Enrollment Date Changes
JIRA Ticket Management Job Aid
Retro Enrollment Requirements Changes Job Aid
Outbound Carrier Request Job Aid
Go here to read EDI Enrollment Files. You will see files that show "OUT" meaning the file was sent out by HC to the carrier, and files that show "In" meaning the carrier sent the file back to HC confirming enrollment.
What can you review on the Softheon Web?
When a Softheon Ticket is marked at this level of severity, it generally takes 3-business days for a resolution.
What is a medium level of severity?
The process that must be completed by Tier 2 agents prior to attaching a template to a JIRA Ticket.
What is encrypt the password?
Member must have at least 1 month of coverage during the year that BLANK is requested.
What is Reinstatement?
To assist a member with Complex Retro Enrollment billing issue I will need to utilize this resource.
I supply you with the details surrounding turn around times expected from 3rd party vendors.
What is Salesforce?
Name the standard operating procedure Tier 2 agents must follow when handling Sotheon requests.
SOP 145 Softheon Inbound CRM
The four categories in the MR Playbook related to MA Login issues.
What is:
Deactivate Account and Unlink Account
Duplicate Account
Login Issue - Email Update
Unlock Account - Password Reset
Take these steps to resolve the following issue:
Unpaid Premium Termination Letter - Notice giving Mr. McMahon permission to reinstate without a gap in coverage.
Mr. McMahon's coverage will end due to non-payment of premium on December 31, 2025
What is:
2025 coverage will require a reinstatement.
Reinstate the member into their coverage plan for 2025.
This coverage will end as of 12/31/25 and will not carry over to 2026.
2026 coverage will be a retro enrollment.
The member has no enrollment for 2026 so the agent will need to add an Admin SEP and help the member shop and enroll in coverage.
Then process the retro enrollment to January 1, 2026.
Close your task before closing your case or you will find yourself with this error message.
What is "Hit a Snag!"