CDAG
The timeframe to process a cd request.
72 Hrs.
Name the state: CA
California
What must be stated if a third party enters the conversation?
Monitoring Disclosure
Replacement ID cards are mailed within _____?
7-10 business days
LIS
Low income subsidy
Requesting coverage of a drug at a lower cost or tier is called ____?
Tier reduction/exception
Name the state: MA
Massachusetts
During PHI verification, what MANDATORY information should we ask from the caller/member?
First name and Last name
EOBs are mailed within
10-15 Business days
SPAP
State Pharmaceutical Assistance Program
Coverage determination unit is open from ____ to ____ est from Monday through Friday
08:00 AM to 02:00 AM
Name the state: CT
Connecticut
Name the 5 account Verifiers
MID/MBI
DOB
Phone number
Complete Address
Invoices are generated between the 6th and the 10th of the month and are mailed by _____?
The 12th business day of the month
CMS
Centers for Medicare and Medicaid Services
An expression of dissatisfaction with any aspect of the operations, activities or behavior of a plan is called?
Grievance
Name the state: MD
Maryland
When Providers call(Doctors/Prescribers, Pharmacist, Hospitals). What 2 information should an advocate obtain?
NPI
Provider name
An address change is considered temporary if the member will reside in his/her new address for up to ____ months?
12
HIPAA
Health Insurance Portability and Accountability Act
Customers who have been disenrolled for more than 60 days are generally ineligible to file grievances unless the grievance is related to _______?
Quality-of-care issues
Name the state: WY
Wyoming
What is the Job aid for CIGNA PHI GRID?
MS0455
All Medicare Prescription Drug Plans are responsible for identifying breaks in creditable coverage of ___ days or more at the time of enrollment
63
IRMAA
Income Related Medicare Adjustment Amount