Shop Sites
Systems
Need To Know
vocabulary
SEP
100

Caller states: 

Can you tell me if my drugs are covered?

What is Shop Sites under Prescription lookup/ Find covered Drugs

100

How would i complete a paper application

What is Epst 

100

Consists of Part A and Part B and is a fee-for-service plan.

What is Medicare

100

is the percentage you pay out of pocket for the cost of a health care service after your Medicare plan has contributed

What is coinsurance

100

You move into a qualified institutional facility

What is.. you are institutionalized 
200

I like going to this hospital because its close to my house, is it in network?

What is Hospital/Facility look up

200

I need to check a POA or authorize representative. Name both ways

What is Cirs and or Signature Authorization tab in medysis 

200

can be purchased to help cover out-of-pocket costs if you have Original Medicare.

What is Medigap or Med Sup

200

you are qualified for both Medicare and Medicaid

what is Dual eligible 

200

Member have full medicaid benefit

What is...you have extra help, MSP and or medicaid

300

I need to know how much an ambulance would charge me in a vehicle or air?

What is check EOC for coverage details

300
I need to submit an application for a marketed plan
What is salesforce
300

Name 4 things medicare do not cover

  • Eye exams (for prescription eyeglasses)
  • Long-term care
  • Cosmetic surgery  
  • Massage therapy
  • Routine physical exams
  • Hearing aids and exams for fitting them
  • Concierge care (also called concierge medicine, retainer-based medicine, boutique medicine, platinum practice, or direct care)
  • Covered items or services you get from a doctor or other provider that has opted out of participating in Medicare (except in the case of an emergency or urgent need)
  • Most dental care
300

A Medicare program to help people with limited income and resources pay Medicare prescription drug program costs

What is extra help

300

Member medicare advantage plan or part D plan doesnt renew its service.

What is...Your medicare plan or part d plan no longer offers medicare coverage

400

Where can you find the list of all coverage drugs under a plan

What is formulary under plan documents 

400

I want to compare plans for a member

What is SF, Mproducer, QRG, and or EPST

400

The official guide to Medicare 

Medicare and You booklet

400

Prescription drug coverage that is as good or better than what Medicare considers its standard

What is credible coverage 

400

Member move back to the US after living abroad

What is..You Move

500

I want to know if my plan have a benefit i can add like dental, transportation, Utilities, DME or Groceries. 

What is Check Plan for EE benefits, Essential extras 

500

I need to check dsnp eligibility for a member. Name all 3

What is Producer toolbox chat box, mproducer, or SF

500

How is a child eligible for ESRD

One of these conditions must apply to you:

  • You (or your spouse) have earned at least 6 credits within the last 3 years by working and paying Social Security taxes.
  • You (or your spouse) are getting, or are eligible for, Social Security or Railroad Retirement Board benefits.

AND

One of these conditions must apply to your child:

  • Your child needs regular dialysis because their kidneys no longer work.
  • Your child has had a kidney transplant.
500

What is the 3 C's in medicare 

what is Cost, Coverage, and Convenience

500

Member was automatically enrolled into a part D plan after identifying their extra help status 

What is...You are passively enrolled into a part d plan or dual eligible snp

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