What is Medicare?
Which part covers Prescription Drugs?
What is Medicare Part D!
“Why do you have to ask for all of these details anyway?” “To be in compliance with ______ regulations, which are in place to secure your ______.”
What is HIPAA, Protected Health Information.
Which STC should never be missed in a Call?
What is ELIZA STC C0283!
What is the name of our main system to upload member's account?
What is CSIM - CPHP.
What actions should you take if a member expresses that they are severely depressed?
What is transfer to the Magellan Crisis Line!
Which part of Original Medicare covers my visits to my Primary Care Physician?
What is Medicare Part B!
Mention 3 components of information needed to Authenticate a call.
What is any of the following: Member ID#, MMN, DOB, Medicare ID#, Name of Plan, Name of PCP, or Zip Code.
Member is calling requesting a Provider Directory, in which STC will we document this call?
What is CP846!
Which system is used as a Rewards Redemption site?
What is InComm!
Which of these are self-service options available within the MyCarePlus Portal; Benefit Information, CP MBR ID Card request, OTC Request, INN-Provider Directory.
What is Benefit Information, CP MBR ID Card request, and INN-Provider Directory.
Define Medicare Part C, and what does it covers?
What is Medicare Advantage MA or MAPD plans from a private insurance company. All benefits and services covered under part A and B, prescription drugs, and Mandatory Benefits like Vision, Hearing, and Dental benefits, by enrolling in a Medicare Advantage plan!
Who has authority over a member's account to receive PHI?
What is a member, POA, CPHI, AOR, EOE, or Verbal consent on the call.
Which STC will you document a MMN change?
What is STC C0301!
STC used to request a new/replacement CarePlus ID Card is _________ and is documented in _______.
What is STC C0352 / CSIM
What is a HMO Plan?
What is plan that keeps costs low by having you coordinate all care through your PCP.
What in cover under Medicare Part A?
What is Hospital, Skilled Nursing Facilities, Hospice Care, Home Health Care, and Blood received at a hospital or SNF during a covered Stay!
Mention the Authentication Steps in a Call.
What is Confirm caller's identity, Validate Authority, Inbound /Outbound, Accuracy.
Which STC should we document a Rewards call?
What is STC C0337 CarePlus Rewards.
Check __________ to see if member has already earned their points for RealAge Test.
What is ShareCare!
CareCard can be used to cover ___ of ______ expenses related to ______, ______, and _______.
What is OOP, Dental, Vision, and Hearing.
Who is eligible for Medicare benefits?
What is Person 65 years or older, Incapacitated, and ESRD.
PHI/PII emergency release to a third party only occurs in what 3 situations?
What is: 1- PHI/PII is being requested. 2- Member is incapacitated or incoherent to where they cannot provide consent for CarePlus to speak with the third party. 3- An unauthorized third party authenticates the member’s account.
A member calls and you realize the member only speaks Portuguese; you call Voiance. Under which STC and how will you document this call?
What is STC: CP770; Part: I-Internal; Call Status: C-Closed.
What is STC Classification List, and Benefit Grid.
Ms. Evans is a CPHI on her mother’s account and complains that at the end of last month, the member’s CareEssentials Card had a balance of $10, but this month, it has a balance of $50. She is upset because she thought it would have a balance of $60, since the member still had $10 remaining from the previous month. Which 2 STCs can be used, and what would you explain to the caller?
What is G077M if verbal consent is obtained, or a C0039 STC if it is not obtained. The balance expires each month and does not roll over.