Definitions
63 days
How long does a member have to submit a creditable coverage attestation?
90 days from the first letter
How do we access the Creditable Coverage Attestation Template in CRM?
Associate the case to the policy and go to available processes.
What are the 2 EMME codes for the "Initial Request" creditable coverage letter?
ME0096 and ME1800
A member calls in on July 9th with an initial request for creditable coverage letter from April 11th, can they take creditable coverage attestation?
Yes they can as it has only been 89 days
The term "as good as" refers to what part of LEP?
Creditable Coverage (as good as Medicare standards)
How long after the plan effective date does the first LEP letter get sent to the member?
30 days
What tool do we use to determine if the member is within their 90-day attestation period?
Creditable Coverage Attestation Calculator
What are the 2 EMME codes for the "follow up request" creditable coverage letter?
ME0994 and ME1801
A member calls in on July 25th with an initial request for creditable coverage letter from April 24th, can they take creditable coverage attestation?
No, they cannot as it has been 92 days
Besides a gap in coverage, what is the other way a member can have a LEP assessed?
They did not enroll in Part D Coverage during thier initial election period.
14 calendar days
Which of the following is NOT a form of creditable coverage?
- VA Benefits
- Employer Benefits
- PACE
- GoodRx
GoodRx
If we cannot locate a creditable coverage letter in RTI or EMME what does that mean?
The member has had a LEP since they were with their previous provider and need to fill out a reconsideration form
A member calls and says they submitted their creditable coverage attestation 2 weeks ago and would like to check the status. Where do we go check the status of their creditable coverage?
PCCV in CI
What is one of the 4 segments of the Medicare Part D population who are exempt from a late enrollment penalty?
- Extra Help Members
- Puerto Rico Medicaid
- Victims of Hurricane Katrina
- Members with creditable coverage during the coverage gap in question
How long from the second letter does a member have to submit their attestation?
15 days
What screen in CI do we check a members creditable coverage status?
PCCV
What form is sent alongside the creditable coverage letter ME3330?
The C2C Reconsideration Form
What does creditable coverage status "M" mean on the PCCV screen mean?
The member creditable coverage attestation has been processed and not further action is needed.
What is the calculation for LEP?
(Uncovered Months x 1%) x National Base Beneficary Premium
How long does a C2C Reconsideration take?
Up to 90 days
What is the EMME code for the C2C reconsideration form?
ME0037
Name one of the initial request letter EMME codes without the use of Mentor
ME0996 or ME1800
What does creditable coverage status "P" mean, without using mentor?
The member's creditable coverage status is pending