HIPAA
SPAP/LIS
COVERAG
DETER
BILLING
QUOTING MEMBER BENIFITS/PART D COV LEVELS
100
Family members can be added as _____authorized representatives by following the verbal authorization process for adding authorized representatives. Please see the process steps for further information.
What is : ONGOING CONSENT
100
THE ACRONYM SPAP STANDS FOR
What is: State Pharmacy Assistance Program
100
what two systems can i use to see a pa after a coverage determination has already been done
What is: is rx claim and rxweb
100
member states they lost their billing statment where do i go to reprint
What is : edss
100
THE FOUR LEVELS OF COVERAGE IN PART D ARE?
What is : DEDUCTIBLE, INITIAL , COVERAGE GAP , CATASTROPHIC
200
This Act. ____ was created in 1996, and addresses a number of issues, including the protection of confidential enrollee information. Prior to any disclosure permitted by____regulations, M&R (and vendors acting on their behalf) must have a process to verify the identity of a person requesting PHI, and the authority of such person to have access to PHI.
What is HIPPA
200
THE ACRONYMS LIS/LIPS STANDS FOR
What is LOW INCOME SUBSIDY/ LOW INCOME PREMIUM SUBSIDY
200
when doing a coverage determination what form must i fill out each time
What is : a pa form
200
what are acceptable types of payments ?
What is :Electronic Funds Transfer (EFT) • One-time Credit Card or EFT transactions • Website One-Time EFT (click to show/hide) - Completed by member via the aarpmedicareplans.com or uhcmedicaresolutions.com website. Payment can be made from checking or savings account. Advise member that a website account has to be set up prior to making a premium payment through the website. See the Online Payment tab of the Medicare Plan Websites job aid for more information. • Credit Card (Recurring) (click to show/hide) CCPs should not actively offer recurring credit card payments. This method of payment should only be discussed by Credit Card Agents during the 1-Time Credit Card Process. If the member mentions Credit Card as a MOP option, CCPs will follow the 1-Time Credit Card process. Check the member notations section on the Summary tab in Account Summary to verify if the member is set up on Recurring Credit Card Payment. If the member has any questions about their current recurring credit card payment that is already set up, do not transfer to the Credit Card Team. Only transfer the member to the Credit Card Team if the member wants to add, stop or change the recurring payment. Use this information to answer general questions related to existing recurring credit payments: The credit card on file will be charged on the 20th of each month, unless the 20th falls on a weekend or holiday--then we will charge the credit card on the next business day. Note: Recurring credit card payments may take 3-5 business days to post to the member's account. Members will receive one additional Monthly Bill after their recurring credit card payments start. Additional bills will not be sent unless there is an eligibility or plan change, or there is a past due balance. Members will be automatically removed from RCC payments if any of the following occur: Member qualifies for extra help (LIS, SPAP, etc.) resulting in the member having a $0 premium. Member elects to change their MOP to EFT or SSA/RRB. Member enters into a repayment plan. Member’s credit card is declined two consecutive months. • Online Bank Payment • Billing Statement (Direct Billing) - Includes payment via checks, counter / temporary checks, money orders, online bank payment.
200
MEMBER WANTS TO KNOW WHAT THE COPAY IS FOR TIER 3 MEDICATIONS WHICH TWO WAYS CAN I FIND THIS ?
What is : Review Rx Benefits , 2015/2016 standalone plan benifits and premium changes
300
An _____ occurs when a member is hospitalized, temporarily incapacitated, or unavailable due to a health issue. Examples include a stroke, accident, or any other unexpected medical emergency.
What is : EMERGENCY SITUATION
300
THE COMBINED TOTAL FOR A QUALIFYING MARRIED COUPLE IN 2015 TO GET FULL SUBSIDY WAS...
What is $13,930
300
im a new agent who hasnt worked rxclaim before what job aid would you give me to follow and ii need to look up if a pa was approved
What is rxclaim-index
300
member calls and wants to set up ssa deductions what are the education points i must give on each call
What is:It can take up to 90 days for SSA Deductions to start or stop. Up to three months of premiums may be taken at the time of the first SSA Deduction. There is a one month delay from the time when the payment is deducted from your SSA check to when it is applied to the plan. Continue to send payments until you receive written confirmation of the method of payment change.
300
member called in because the plan hasnt paid anything on her tier 3 medication and her plan just started what level of coverage is the member in?
What is : DEDUCTIBLE STAGE
400
Members have the right to see and obtain a copy of health information that may be used to make decisions about them such as claims and case or medical management records. Requests for access take approximately 30 days from receipt of the completed Request for Access form to process.
What is: Member Rights Requests
400
I need to find a list of the participating spap states where do I go?
What is : SPAP COVERAGE LIST
400
once in rx claims what is the correct number i should enter to see pa
What is prompt 9
400
member calls in about wanting to set up eft what are the talking points that i must give on each call
What is You may sign up for Recurring EFT by sending in an authorization form or by signing up for automatic deductions through our website. Reminders: The EFT form is included in the member’s billing statement. Forms can also be sent as fulfillment items or located on the plan website. EFT Authorization Form on billing statement Reference: Medicare Plan Websites Index for additional information Online EFT requests are processed overnight the same day they are received. If the EFT request is sent by mail or fax, it takes approximately 17-23 days from the date the form is sent to receive confirmation. Note: If members indicate the recurring EFT is taking longer to set up than expected, please reference Delinquency - Call Scenario - EFT Up to an additional $200 may be drafted from your bank account if you lose your premium payment assistance. You will be notified on your billing statement before additional funds are drafted. EFT Payments and Monthly Bills - Retroactive Eligibility Changes and New Recurring EFT Continue to send payments until you receive written confirmation of the method of payment change.
400
THE COMBINED AMOUNT PAID BY BOTH MEMBER AND PLAN TAKES A MEMBER TO THIS STAGE
What is : COVERAGE GAP
500
If the member is deceased and a person is NOT a Legally Designated Person : Executor, Trustee, Guardian or other third party with legal documentation to act on behalf of the member’s estate. What inforamtion can be provided?
What is: * Basic Plan Information *Member Claims Information *Member Enrollment Information (Includes Premium History)
500
I NEED TO VERIFY WHAT COPAY STRUCTURE SPAP MEMBERS SHOULD PAY FOR EACH LEVEL OF SERVICE WHAT SHOULD I REFERENCE
What is : SPAP STATE
500
what are two things i can do a coverage determination for
What is part d excluded drugs and quanity limits, non formulary , lower tier and pa
500
member calls and wants to change from eft to ssa as mop what job aid should you pull up and follow
What is Premium Payment - Method of Payment Changes
500
THE MEMBER IS NOW ONLY PAYING Greater of 5% or $2.65; All Other: Greater of 5% or $6.60
What is : THE CATASTROPHIC STAGE
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