Medicare/GPS
Member documents can be found where in GPS
Where is under policy name, Health Policy Documents?
The P in PEAS stands for
What is Paraphrase?
True or False: When documenting a call, is it okay to not document everything?
What is false?
This system is used to make payments
What is PNC?
True or False: Can we file a grievance against a doctors office staff for being rude?
What is TRUE?
Benefit SR's are created how
Where is in the benefit tab, clicking on SR Box for benefits discussed?
True or False: The A in PEAS stands for action?
What is false?
When documenting a call, we want to include the 5 ______
What are W's?
Where can we find documents that have been mailed or faxed to Aetna
Where is ECHS?
How do we start the grievance process?
What is clicking on create service request, drop down to complaint/appeal/authorization?
The 3 things needed to close a case
What are subject, case comments and service request?
When a member is having an issue we should show ________
What is empathy?
True or False: Should we include curse words when documenting a call, including all words used?
What is false?
Daily Double!!!!!!!!!!!! Must answer both correctly to earn the points.
There are two systems to check a members Medicaid level, those systems are _________ and ________
What are Market Prominence and Marx?
How long does a member have to file a grievance?
What is Grievance’s must be filed within 60 days from the date of the incident?
Daily Double!!! Must answer both questions correctly to earn the points....
Name the 4 types of Medicare plans and which plan pays for hospital cost?
What are Parts A, B, C, and D?
What is Part A?
Recapping what the member called in for is called ____________
What is summarizing?
If we quote it we should ___________
What two systems can we locate authorizations in?
What are Evicore and MedCompass?
What system do we check to see if member has an active grievance?
Where is MedHok?
A member has ________ days to get creditable coverage before getting a ____________
What is 63 days?
What is LEP (Late Enrollment Period)
After the member states what they need help with we should _________
What is paraphrase?
Case comments should be considered a ______
What is a legal document?
We can find blank documents to send to members in what system
What is OneKit?
When a member calls in upset with an issue that affects their Medicare, we should ask permission to file the grievance for the member?
What is no, if the caller expresses dissatisfaction, and it meets grievance criteria, INFORM the member/caller that we will be filing a grievance on their behalf. If the member/caller does not want to have a grievance filed on their behalf, follow the steps in KA for Medicare Member: Withdrawing a Grievance?