This screen is a place to post information that is vital to keeping employees informed about group and subscriber records, and about the actions each employee has taken to create and maintain those records.
What is the Comment (25/CMENT) Screen?
100
Name the two main ways to conduct research to locate a provider.
What is LMOM and Find A Provider?
100
This is required on DIRP/COBRA accounts, unless it is a 120 Day Survivor.
What is a Welcome Letter.
100
When a retro transaction does not match myCalPERS, this must be done.
What is submit a Retro MRF?
100
A subscriber that is open on more than one plan can cause these two things to happen.
What is the subscriber can get stuck and claims can suspend?
200
The _________________ is generated when a subscriber is electronically enrolled, or enrolled using the ANSI Enrollment Tool. It is manually generated when a manual enroll is processed.
What is the Label/Welcome Kit?
200
When assigning a PCP to a newborn, this rule must be followed.
What is assign to Mom's IPA, or Dad's if mom is not enrolled on the plan?
200
The maximum number of months a member can have on COBRA.
What is 36?
200
A dependent address should be entered in RTMS when it is different from __________________.
What is the subscriber's mailing address?
200
Use Extent 1 is for _____________________ and Extent 9 is for ____________________________.
What is too many dependents and COBRA/DIRP?
300
In MyCalPERS the __________________, and ________________ name are used in conjunction with each other to ensure that each member is placed in the correct group number and billing unit.
What is the Payroll Office Code and Plan
300
When performing a buddy audit/inspection, enter this command to look up the IPA Service Area?
What is stop,sa,hmhmos,beipa(IPA#)?
300
This DIRP plan requires a billing address.
What is 120 Day Survivor?
300
The subscriber's mailing address is entered as the _________________ and the subscriber's physical address is entered as the ______________________ in RTMS.
What is GENERIC and OTHER?
300
This command should be entered in RTMS, prior to enrolling a subscriber, to determine if they have an existing certificate number?
What is stop,271,C or stop,MXSSN,C?
400
The Screen Number or Screen Short Name for Subscriber Benefit Section, Comment, and Subscriber Enrollment screens.
What is 29 (SUBBE), 25 (CMENT), 31 (SUBEN)?
400
The Member Zip field on the PCPSL (120) screen must be the same ZIP that is used ___________________. (NOTE: This is also called the Service Area ZIP).
What is to determine eligibility?
400
When performing a transfer from a Direct Pay or COBRA account, and the Accrued To Date (ACTD) is less than the effective date of the transfer, you must do this.
What is generate a nextbill?
400
Overage dependents are cancelled on this date.
What is the first of the month following their 26th birthday?
400
List four triggers.
What is:
*Nextbill
*ID Card
*S-PSC
*Label/Welcome Kit
*HIPAA
500
Name three agencies that use myCalPERS for their health enrollment information.
What is State Agency, Public Agency and CCPOA. (NOTE: NonCentral is acceptable too)
500
Name the three situations when a processor may override the IPA service area edits for existing members.
What are Group to group transfers, Reenrollments with no lapse in coverage and Address changes?
500
Name four of the fields that are required to be entered on COBRA accounts.
What is the dept code, COBRA start date, number of months and COBRA QED.
500
Name the one time an ID card is not required on a name change.
What is on a cancelled/future cancelled account?
500
Name four situations where a label/welcome kit is required.
What are:
*New Enrolls
*Re-enrolls if the sub was not effective in the current year
*Transfer from CalPERS and CCPOA,
*Transfer from Access+ and NetValue,
*Transfer from HMO and EPO