DSNP Basics
What does DSNP Stands for?
Dual Special Needs Plan
Which Intent we use to check the medical benefits?
Review Medical Benefits
Where do we see medical claims?
Review medical claims history
We enroll members on DSNP plan?
No
Aligned: UHC manages both Medicare and Medicaid
Unaligned: UHC manages their Medicare and another MCO (Insurance or State) manages their Medicaid
What types of plans does DSNP have?
HMO and PPO
What does LIS stands for?
Low Income Subsidy
Mention 3 claims parts
Claim Detail, Provider Detail, Service Line Detail, Financial Detail
What does AEP stands for?
Annual Enrollment Period
A member who qualifies for Medicare and also has full Medicaid Benefits
Full Medicaid (QMB+, SLMB+, FBDE)
Who qualifies for DSNP?
Medicare Parts?
Part A, Part B, Part C, Part D
Explain how we find a PA on ICUE
First we select the member section on ICUE, then we write down the member ID and search it, once we have found the member information, we click on Charts tab, if we scroll down we will find all the PAs.
AEP Dates
October 15- December 7
Is a joint federal and state program that helps pay medical costs for certain groups of people with limited income and resources, such as pregnant women, children, and the aged, blind or disabled
Medicaid
What does UHC C&S DSNP stands for?
United HealthCare Community & Sate Dual Special Needs Plan
Medicare benefits?
Pharmacy, medical, providers visits, outpatient and Inpatient
Why would a medication will need a PA?
Medications can be addictive or too strong for member and they will need to be approved by the insurance for its coverage.
When caller calls saying member died what we do?
Advise caller to call social security to report the death
When member loses Medicaid eligibility he enters a certain period, what happens when he enters that period and how do we call that period?
Its call grace period, this happens when the member loses Medicaid eligibility and he will be considered as a partial Medicaid and will pay cost shares and may pay monthly premium.
Can members be enrolled automatically on DSNP?
Yes, when they are enrolled on a UHC plan, are 65+ years and qualified for Medicaid they automatically get enrolled on DSNP
UHC benefits?
Rewards, OTC, utilities payments, housecall
Mention the 3 parts of the Claim Financial Summary we should focus on
Allowed, Total Member Responsibility, Net Paid
SEP dates
January-March, April-June, July- September
How long does the grace period lasts?
6 months