Medicare 101
PPO means
Preferred Provider Organization
Sept. 3-30
ANOC and EOC are mailed out
What is the first step in the call flow?
Greeting the caller
What 2 things authenticate a provider?
NPI/tax ID
SNP
Special Needs Plan
HMO means
Health Maintenance Organization
annual enrollment Period
10/15 - 12/7
Show empathy is what step in the call flow?
Step 2
What are the 3 main things that authenticate a member?
Member ID
Zip code
DOB
RRB
Railroad Retirement Board
The person receiving the benefits.
Beneficiary
Jan 1- dec 31
Policy effective dates
How many steps are in the call flow?
eight
What button do you press when talking to the member
Interacting with and about
Premium
Amount a member pays monthly for insurance coverage
What does CMS stand for?
Centers for Medicare & Medicaid Services
Jan 1- March 31
Open enrollment period
What is the 4th step in the call flow?
Resolve the issue
Interacting With
When talking to anyone other than the member.
PDP
Prescription Drug Plan
# things that qualify you for Medicare?
3 months before or after turning 65
ESRD
Be on disability for 2 years
period when Medicare members can enroll in or change their existing Medicare advantage plan
Open enrollment Period
What does solving inquiries reliably mean?
Giving precise and accurate information
When you get permission over the phone from the member to speak on their behalf
Verbal consent
Benefits that replace some of your earnings when you retire
SSA BENEFITS