Enrollment/Eligibility
Who is Eligible for Medicare?
What is age 65 and older, under 65 with certain disablilties and ESRD.
Which system is used to process a one-time payment or set the member up for auto debit? What KA's can assist?
What is PNC, (KA 2706 and KA 2708)
What must you verify to check if a benefit has been used ?
What is Accumulators
Paper claim IDs begin with the letter M. Images of these claims can be found in what system ?
What is ECHS or IOP
What Service Request Reason would you choose under the “Add a Service Request” button, to file an oral grievance in GPS?
What is Complaint/Appeal/Authorization
What Member Account Changes CANNOT be made unless information is verified in MARx first?
What is Name, DOB, MBI, Gender
After what date of each month is a premium payment considered past due?
What is after 10th of the month.
What costshares count towards the Member's Maximum out of pocket (MOOP)?
What is Deductible, Coinsurance, Copays
Reworks should be processed in what system ?
What is GPS
What system is used to check the status of an appeal or complaint ?
What is Medhok?
(LEP) is assessed __ days after the date at the top of the beneficiary’s initial notice letter. The beneficiary then has an additional __ days from the first initial letter date to complete their attestation.
What is 30,60
What would cause a member to pay a different amount than the standard premium?
What is OSB's, LEP, LIS, SPAP
If a Member is not happy with their medical coverage, What election period will allow the Member to Join, Drop or Switch and when?
What is AEP 10/15-12/7
Using ID:EFPDP7BJW.Does the Member have any responsibility?
What is mm is costshare protected $0
What are the Different types of grievances that can be filed?
What is first call resolution (FCR), Quality of Care, and Regular Grievances
Prospective enrollees have __ days from the date of the letter or the end of the election period, whichever is later, to respond with the necessary information when their enrollment application is incomplete
What is 21 days
EFT will be Drafted for Members during what time ?
What is 10th of the mth no later than 15th of the mth.
What are all of the possible wallets offered on the extra benefit Card?
What is healthy foods, extra support, OTC, CVS OTC, and medical expense wallets
What resource can be used to get simplified wording on message code denials?
What is e.policies
What form is needed for a caller NOT AUTHORIZED on the member account, to file a complaint or appeal?
Would you still file the complaint or appeal?
What is the Appointment of Representative (AOR) form.
Yes, the AOR form is needed to process the complaint or appeal.
What does MIUS stand for and what are two examples of the correct use of this heldesk?
What is Medicare Internal Urgent Support Team.
Examples include:
Payment Options Include
What is
Monthly Invoice
Electronic Fund Transfer (EFT)
Social Security Administration Premium Withhold (SS PWH).
Using ID:102155545100 and Stars central portal does the MM have the extra support wallet ? If so what is the allowance amt.
What is no! Members must have one of the 17 filed chronic conditions in order to qualify.
What is ABZI
What are the turn around times for these 3 type of request?
-Standard Pre service Authorization
-Standard post service appeal
-Standard Grievance
What is 14 , 60, 30 days.