A federal health insurance program for people who are:
65 or older
Under 65 with certain disabilities
Of any age and have End Stage Renal Disease (ESRD) or ALS
100
What does AEP stand for?
Annual Enrollment Period
Can also be known as OEP (Open Enrollment Period)
100
How many total Call Center sites does M&R have?
42 Nationwide
100
What is does CTM stand for?
Complaint to Medicare
100
Who is our Senior VP of Operations?
Jim Becker
200
What is Medicaid?
A joint federal and state program that helps pay health care costs for certain people and families with limited income and resources. Different programs under the Medicaid umbrella are designed to help specific populations.
200
How long does AEP run?
Medicare Open Enrollment—happens every year from October 15 to December 7.
200
Name one of the methods of communication Members receive after enrolling in UHC Medicare Insurance
-Welcome Packets
-Warm Welcome Calls
-Just Checking In
200
What is NPS and why is it important?
NPS= Net Promoter Score
This measures level in which members or employees are satisfied with their service/employer and whether or not they would refer the service to others.
Think of this as free Marketing, we want it to be good!!
200
Who is the CEO of UHC M&R?
Steve Nelson
300
What does Medicare cover?
Care and services received as an inpatient in a hospital or skilled nursing facility (Part A)
Doctor visits, care and services received as an outpatient, and some preventive care (Part B)
Prescription drugs (Part D)
300
Name 2 Channels/Methods of Enrollment
(How can a member enroll in Medicare?)
1. Field Agent (Agent comes to home or community)
2. Telesales (Member calls in via Telephone)
3. Web (Member enrolls online via UHC portal)
300
Name one internal program that helps members close gaps in care
-Housecalls (Doctors or Nurse Practitioners will come to members home to conduct annual medical exam)
-Advocate4Me- Schedule appointments on behalf of the member
300
With the quality work we do today (2016), what year will this actually impact our STARS ratings?
The work we do today impacts our 2018 Star Ratings (2019 payment year).
300
Name 3 Initiatives the oMOP team has helped with
-Provider Directory Policy
-eFulfillment
-Ask an Advocate Day
-Asian Initiative Expansion
-AEP Provider Data Booster
-Roster Cleanse
-Gatekeeper Plan Rollouts
HEDIS= Healthcare Effectiveness Data and Information Set
HEDIS measures address a broad range of important health issues. Among them are the following:
Asthma Medication Use
Persistence of Beta-Blocker Treatment after a Heart Attack
Controlling High Blood Pressure
Comprehensive Diabetes Care
Breast Cancer Screening
Antidepressant Medication Management
Childhood and Adolescent Immunization Status
Childhood and Adult Weight/BMI Assessment
400
Name 1 of 3 Regional CEO's
West- Brandon Cuervas
Central- Elena McFann
East- Dennis O'Brien
500
Can you have Medicaid if you have Medicare?
If you qualify for both Medicare and Medicaid, you are “dual eligible.” Sometimes the two programs can work together to cover most of your health care costs.
500
Which of the 4 Regions currently has the largest amount of M&R membership? (as of November 2016)
MA Membership- West (885,302)
PDP Membership- Central (1,337,439)
500
Who oversee's all of M&R Customer Service?
Mike Baker
500
What are 2 of the top reason's a Member would file a CTM?
1. Provider Issues
2. Drug Coverage Issues
3. Effective Date Issues
500
How many active members does UHC M&R serve today? (As of 11/30/16)