CMF (Call Management Framework
what is the the ability to adapt to the caller's tone and energy?
Personality Flexing
Where on NGD can I find if my Bene is elgible for another Part B/Preventive Service?
BCC Tier 1 > Preventive Services View
The MA-OEP Enrollment period is from...
January 1 to March 31 every year.
What is level 3 of the Appeals process and how long does a bene have to file a claim with the?
Decision by the office of Medicare Hearings and Appeals and the Bene has 60 Calendar Days from the date they receive the level 2 appeal decision.
Coverage Gap is also Known as the What?
"Donut Hole"
Which part of the CMF is Listen and take notes?
Listen, Question, and Confirm
Where on NGD can I opt my Bene out of Data Sharing?
Does Medicare Cover anything Related to Coronavirus?
Yes, Medicare covers health care provider-administered coronavirus testing and the coronavirus vaccine.
for a single individual in 2026, what is the maximum gross income they can make to qualify for SLMB (Specified Low - Income Medicare Beneficiary?
$$1,616 per month (Income may be slightly higher in Alaska and Hawaii)
when looking up a plan or a provider and the bene mentions customer service is important to him, what filter would you adjust to better meet his/her needs?
Star Ratings
What Phase is "Following Critical Business Practices" in the CMF?
Phase 3: Provide Solutions
After completing all tasks on NGD, where do i go to "Close Call"
if a bene is confused on which plan to choose within the plan finder, which technique can you focus on to narrow down your search.
The 4 C's (Cost, Coverage, Convenience, Customer Service)
When discussing coverage for a "Nonworking Spouse" with a bene what are 4 ways they can qualify for Medicare?
The "MBR" (Master Beneficiary Record) Feeds into the "BIC" (Beneficiary Record), which then Feeds into the What?
"CWF" (Common Working File)
What Phase is "Do An NGD Quick Check" in the CMF?
Phase 2: Listen, Question, and Confirm
Where can I go to see how many LTR days a bene has remaining/Used?
BCC Tier 1 Scree > Part A and B Benefits > Lifetime Days Remaining Form Applet
How many Plans can you compare in the plan finder, at once?
3
When a bene has Supplemental Insurance, does this pay before or after Medicare?
Typically, Pays After.
What must a bene be enrolled in to automatically qualify for Extra Help?
Medicare and Medicaid
What Phase is "Take the Call" in the CMF Framwork?
Phase 1: Receive The Call
where on NGD can I see if the bene has opted out of Part D Autoenroll?
BCC Tier 1 > MA-PDP View > Ma-PDP Information Form Applet
SEP (Special Election Period)
When a Bene wants to opt out of autoenrollments, what is your next step as a Gen Med Tier 1 CSR?
Transfer to a Tier 2 CSR to complete the opt out process.
If your Group Health Plan has 20 more employess, who pays first?
Your group health plan pays first, and Medicare pays second. Medicare is the secondary payer on hospital and medical bills if: