Facets
How do you search for a member in Facets?
Last name & DOB | Member ID.
Age 65+
Disabled
ESRD
Under which section would you locate if a member had a credit on their account?
Billing summary -> Billing Entity
What must go in our C section?
The callers concern, including who we are speaking with.
If a member wants to see a dermatologist, which benefit would you quote?
Specialist.
Which tab shows the members effective date?
Eligibility Tab
Who is the primary insurance with a Medicare Advantage plan?
The Medicare Advantage Health Plan.
Where would we see the payments that have been received in Facets?
Billing summary -> Receipt History
Under what section to you document your S and R?
New Task Notes
When quoting cataract surgery, what must you remember to quote along with it?
Eye wear post cataract surgery.
Where would you find the member's prefix?
Look in the General Tab.
Who handles the Medicare calls &/or questions?
Social Security Administration.
If I lived in Steuben County and had a Medicare Blue Secure plan, what would my premium be without assistance?
If you are documenting a call regarding a question about their premium payment, what would be your category & subject?
Medicare Billing -> Billing / Check / Payment Res (WF)
Do we offer any coverage for Wigs?
No - benefit was discontinued.
Under which section would you see if the member has a late enrollment penalty?
T | F: Member are still required to pay their part B premium even if they are enrolled into a supplemental or advantage plan.
True.
Which plans do not offer prescription coverage?
Select, Basic and Platinum.
When you have to send something to another department through Facets, how many documentations will you have and what are the status of each?
2 - One will be pended/workflowed to the department and the other will be in an open status.
If a member goes into the ER and then is admitted into the hospital as inpatient, what benfit(s) would you quote?
It would switch from ER to just an inpatient benefit.
How do you locate the DCN for enrollment?
In order to get a Medicare Advantage plan, what must a member have?
Live in the service area
No ESRD
What would my monthly premium be if I lived in Wayne County, had the Optimum plan and had 100% LIS and EPIC assistance?
$171.77
What must you put at the end of all documentations?
Member understands / Non-member understands.
60 days