Random #1
Who works with PDPs (prescription drug plans)
Original medicare
If you answer the call and there is no response what will this call be considered as?
Ghost Call
What are the 4 new Essential/Everyday extra benefits for 2020?
Pest control, Healthy Nutrition, Health and Wellness Device, Service dog support
What pharmacy is anthem going to start using 2020?
IngenioRX
What approves for medicare/medicaid appeals decision?
What is Maximus?
What does I.P.A mean?
Individual Practice Association
If a member calls and is very irritate and using lots of profanity and making threats what will this call consider as?
Abusive
What are the 2 new plans for 2020?
Medicare Advantage Choice (HMO-POS), Medicare Advantage Extra (HMO)
Anyone with medicare coverage is eligible? True or False
True
What is an alternate system for locating member?
What is Medisys?
If provider is appealing claim for member their must be an ____ form on file
AOR (appoint of representative) form
What is the 3 main things that you must receive from the member before ending the call?
HIPPA verification
Does 2019 Everyday Essentials automatically renew for 2020? Yes or No?
Yes
Which drugs are not covered by Part D? Barbiturates, Drugs to treat Anorexia Drugs approved by the FDA
Drugs to treat Anorexia
What are "MMP" & "ENSHUL" considered as?
Other Dual Plans
This includes Part B, Patient has 20% coinsurance, Insulin pump.. etc
Diabetic coverage
Are workbaskets appropriate for every call?
No, only if there is a follow-up needed
What vendor will be the hearing care for Texas MMP plans in 2020?
Hearing Care Solutions
When enrolling in a new plan, a beneficiary will be entitled to a transitional supply of drugs that are not on the new plan's formulary. That transition supply will be for how many days?
30 day supply
What is a percentage of costs a covered member pays after they have met their deductibles?
Coinsurance
These people handles claims that didn't process correctly or not all all..
Rapid response Experts
If member calls and states that they have called a government agency, mentioned that their medical care or prescription drug access has been denied, what type of call will this be considered as?
Escalated
In 2020, members will be able to get 30 days supply of this..
Opioids
What are some costs associated with part D?
Annual Deductibles, Monthly premiums, Adjusted monthly amounts or IRMAA, Prescription cost shares, copays the coverage gap and any coinsurance amounts.
What do members NOT pay when they receive extra help or LIS?
LEP ( late enrollment penalty's)