Acronyms
LEP
Late Enrollment Penalty
What is LEP?
the late enrollment penalty is a fee from CMS when a retiree does not enroll in a prescription drug plan when eligible, and it lasts as long as retiree has insurance.
Who is the author of el Quijote?
Miguel de Cervantes
Members can get confirmation of payment by their email
True
You identified a capitated claim when you notice that claims are denied and reason of denial is due to capitation.
TrOOP
True Out of Pocket
What is a crossover claim?
it is when you jump from a coverage stage to another, as an example from deductible to initial coverage
when did the world war II begin?
in 1939
Medicare Advantage plans will cover members for emergency situations out of the united states.
True
If you are facing a RxCOB denial claim what is the next step to follow.
1. ask the member if they have a secondary insurance
2. Call COBR and make a conference call
3. Do the RcCOB flag removal in macro
4. Call the pharmacy.
COA
Credit on account
what is the LIS?
the low income subsidy is granted from SSA and is for people with low income and will have help for insurance precription drug premiums and prescription copays.
When did dario gomez pass away?
july 26, 2022
With preferred pharmacy members will pay higher copays than standard ones
False
If a member wants to get a refill from the pharmacy because wants to go on a vacation, what would you do?
1. get a denial claim from the parmacy.
2. call the helpdesk transitional override department
3. call the pharmacy and process de claim again.
C-SNP
Chronic Special Need Plan
What is the Donut hole?
Most plans with Medicare prescription drug coverage (Part D) have a coverage gap (called a "donut hole"). This means that after you and your drug plan have spent $5030 for covered drugs, you have to pay 25% and UHC 75% of the cost of the medication.
Which member of the Beatles was murdered?
John Lennon.
With capitated claims members will pay the full price since claims are denied.
False
If a member states that they have credible coverage but it is more than 90 days from the initial letter what would you do?
Advise member to send a letter to C2C to appeal the LEP
MIOD
Member Initiated Organization Determination
What is capitation and delegation?
Capitation is an agreement of payments in advanced (Per member per month) in which providers can assume finantial risks in UHC medical claims will display as denied.
delegation is a third party (PMG provider medical group) that handles some tasks like medical claims.
What is the capital of Iceland?
Reikiavik
we can look for hearing aid providers
False
If a member cannot punch in the 16 numbers of their CC number, what would you do?
activate the speech exeption in genesis