Medicare Terminology
Federal agency within the United States Department of Health and Human Services (HHS) that administers the Medicare program.
Centers for Medicare & Medicaid Services (CMS)
January 1 - March 31
OEP
This system is used to view and update pended enrollments.
Automated Enrollments
(Also acceptable HODMOD)
Annual Period when beneficiaries can join a Medicare Advantage or Medicare Prescription Drug plan.
Annual Enrollment Period (AEP)
October 15 - December 7
What is the first thing you should do upon beginning your workday? (A Day in the Life of an AE Specialist)
Log in to Systems
Helps cover inpatient care including critical access hospitals, skilled nursing facilities, hospice care, and some home health care.
Medicare Part A
When are members notified of changes to their plan?
Notification is sent to members starting in September advising them of any changes to our plans. This is done in preparation of AEP.
Intranet database used to research policies and procedures. Also used to for guidance on resolving pends.
Mentor
Used for PDPs and MAPD plans
IEP
To view applications completed online, the AE Specialist must access______.
FastApp
Also known as a Medicare Advantage Plan
Medicare Part C
On which page of the enrollment application do we find the Primary Care Physician (PCP) name and ID number
Page 1
System that gives a single view of the consumer to provide an integrated service approach.
- Create and update cases
- Add notes, classifications, and intent
CRM
Individuals “aging” in to Medicare (turning 65)
•Can be used for MA and MAPD plans
•Can be used only to enroll in a plan
•Election Type Code (ETC) = I
ICEP
This is important because it is the “rule book” for how insurance companies must comply with government regulations.
Chapter 2 Guidelines (CMS Guidelines)
Additional coverage above the scope of MA and MAPD. May include Dental, Vision, Fitness, and other plan options.
Optional Supplemental Benefit (OSB)
This form is used when a member requests a plan benefit package change
Abbreviated Enrollment Form (AEF)
Humana’s letter repository for creating, reviewing, approving, sending and storing all communications sent to providers, members and groups.
EMME
Members can enroll in a Medicare Advantage (MA) Plan OR make changes to their current plan, ONLY if they meet certain, special exceptions
SEP
Screen in AE from which you extract DCNs
AEDC
A type of plan that provides more focused health care for specific groups of people, such as those who have both Medicare and Medicaid, or who have certain chronic medical conditions such as diabetes.
Special Need Plan (SNP)
A member is moving from Michigan to Ohio. He changes his plan without requesting an SEP. When did the member move?
October 15 - December 7
Used by AE Pends Specialists to draw new work and manage pended work.
MACESS
Individuals new to LIS may use this SEP Reason code
HLP or NLS or LLS
A