Enrollment
What will be the account status in Careconnects if the member's application was received but is not yet finalized?
Pending
If the member wants their specific medication to be covered by the plan, we can assist the member in completing _________?
Coverage Determination
If member's request for SSA/RRB deduction was denied, we will send _________ to the member.
Coupon Book
If a member requested for a billing coupon or itemized statements, you'll process the request using ______________?
Material Request Call Driver
Express Scripts will not fill most prescriptions written for less than a __________________?
35-day supply
CMS automatically rejects application if the member/beneficiary his already enrolled in another non-Wellcare plan. This eligibility issue is called _____?
EIOP (Enrolled in Other Plan)
What's the indicator in Careconnects that the member is receiving subsidy from SPAP?
Third Party Partner ID in Member Plan History (Eligibility Spans)
If the member is receiving 100% subsidy for LIS or Extra Help, they are still subject for Failure to Pay (FTP) if they are on ____________.
Value Script Pan
___________________ is a letter that informs the member that they have been provided with a temporary supply of medication due to Transition of Care.
Pharmacy Transition of Care (TOC) Letter
When a member says specialty medications should be available at additional pharmacies, it is an example of _____ _______?
Member Suggestion
If the member/beneficiary failed to respond and provide missing information (RFI) within the given timeframe, you'll see ______ term code in Careconnects.
EIUWG
What's the indicator in CSP if the medication is an Opioid medication?
Code: 925
Members will not be responsible for LEP if they are receiving __________?
LIS, Low Income Subsidy, or Extra Help
If the member requests for a translated version of their ANOC, the process is called ________?
White Glove Request
If an Appeal is upheld, the member may request a 2nd level appeal to ____________________?
Independent Review Entity (IRE) - C2C Innovative Solutions
When a member requested to cancel the plan and the plan is already effective but there OB2 indicated date has not yet passed, we will process _____________.
Cancellation of Enrollment
What type of medications are not available for transition fill?
GLP-1, B vs. D, and Excluded drugs
What call driver are we going to use if a member called about their Health Reimbursement Account (HRA)?
Billing Cycle Inquiries
This explains your Wellcare Part D prescription drug coverage, including covered medications, costs, pharmacy network, drug tiers, and additional benefits such as vaccine and insulin coverage.
Summary of Benefits
Any complaint with operations, activities, or behavior of Part D plan and has a resolution requirement of within 30 days is called ______________.
Standard Grievance
After OBV has passed, how should cancellation request be handled?
Process as disenrollment / Disenrollment process
In CSP claims history, what do we call the amount member paid that applied towards the specific benefit stage?
Patient Pay Amount
What call driver will you use if the account was termed due to FTP but the member insists that they are approved for Extra Help?
LIS/BAE Call Driver
This form should not be proactively offered and should only be offered if the member states that they are unable to write a letter requesting to discontinue the plan or if they specifically asked for it.
Disenrollment Form
If the member provides 1/8/1942 but shows 1/1/1942 as their DOB in the system, we should ____________
Continue with the call / proceed