What System do I Check
System used to verify if a member has a MMP Lite plan or MMP Full Plan.
What is Facets?
Caller is satisfied with resolution. No further action needed.
What is a Wrap-up?
This number is used to search member accounts in Facets.
What is Family Link?
The number of pieces needed to verify who the caller is.
What is 3 pieces of HIPAA informaiton?
This system is used to send member materials.
What is Macess?
All calls should start and end in this system! Facets should ONLY be used when an intent is not available in Maestro.
What is Maestro?
The Standard Operating Procedure used to document calls for the state of Ohio
What is the Medicaid Call Documentation (OH) SOP?
This site is used to search for Dental Providers.
What is Dentaquest?
A general expression of dissatisfaction about UnitedHealthcare, practitioner or any matter (other than an action).
What is a Grievance?
This part of medicare is the prescription drug coverage, available through Medicare-approved private insurance companies.
What is Medicare Part D?
System used to search the member's RX history?
What is RxClaim?
This system is referneced to find a process or steps to complete a call.
What is KC (Knowledge Central)?
This site is used to search for Vision Providers.
What is March Vision?
A decision about Part C payment or benefits, or the discontinuation of health services that the member believes they are entitled to
What is an Organization Determination?
This part of Medicare covers medically necessary doctor services, screenings, DME, ambulance transportation, outpatient Hospital Care, mental health services, and some home health care services.
What is Medicare Part B?
Member calling to check status of his power chair authorization
What is ICUE?
This system is used to search for medical providers.
What is Rally?
This team acts as a resource when you are stuck on a call; last resort
Who is NEST?
This request is submitted when the member is wanting a prescription covered that is not covered.
What is a Prior Authirization?
This site is used to search member benefits with MMP plans.
What is B360? (Benefit Summary)
This system is used to request coverage for a script that is not covered, has quantity limits, or step therapy is needed.
What is PAS (Prior Authorization System)?
System is used to communicate with members, internal departments, and external vendors.
What is VCC?
"I want to make sure you receive the most appropriate service, do you currently have concerns for your safety, hurting yourself, or someone else" What is this type of question?
What is risk-screening question?
This person has complinace related matters pended to them.
What is a Gatekeeper?
All OH MMP grievances, and appeals should be routed to me in CSP,
Who is KWOODDE?