Benefits
Restricted to a specific pharmacy, clinic, or hospital
What is a restricted member.
The days a member has to file a Medical Appeal with UCare
What is 60 days of the notice of our decision
Knowledge Article to access TAT for various things.
Common Turn Around Times
The six acceptable forms of PHI?
What is Member ID or PMI number, Member name, Date of Birth, Address, and Phone Number.
The task you use to document a member's benefits.
What is View Benefits task
True or False - All members automatically receive their Visa card when they enroll in one of our plans.
False
Member needs to know where they can go and get an Rule 25.
Counties and Provider Offering a CD Rule 25 Assessment
The eyeglass copay for MnCare is this dollar amount
What is $10.00 copay
Online scheduler to assist members with renewing their eligibility with Medical Assistance/MNCare.
What is Portico
Offered to every member after receiving written notice of a denial, termination, or reduction or services
What is an Appeal
This many seats are on the UCare bike
What is Five
The written document giving someone authority to act on behalf of another person regarding their legal matters. It is a legal, notarized form.
What is Power of Attorney (POA)
The task you use to document a grievance.
What is Log a Complaint or Compliment task
This is where you can find all of the Health Promotion Rewards for the specific year.
What is:
Health Promotion Page " Year Rewards Grid"
Fraud: An intentional deception or misrepresentation made by a person with knowledge of the deception but following through anyways.
Knowledge Article: Member Services Fraud, Waste, and Abuse (FWA)
The MSC+ plan covers this number of days of nursing home care
What is 180 days
A member needs assistance completing their application for renewal
What is Portico.
Offered on every call when a member expresses dissatisfaction, is upset, or angry
What is a Grievance
The page to find CS Intake Forms
Main page of CSI under Additional Resources
True or False:
Representatives can speak with authorized representatives who are found in FUSE.
What is True.
The task you use to document a member name change.
What is the Update Demographics Task
UCare customer service can look up a One Pass member code at https://www.partneroptumfitness.com with what information.
What is:
The member is calling, requesting an interpreter for an appointment scheduled.
Language Services
The benefit category for homeopathic and herbal products is available for PMAP members.
What is Services We Do Not Cover
The database you can use to see if a member is active/inactive with the State.
What is MN'Its
The delegated business in which a member should be transferred to file a dental grievance
What is DentaQuest
"How to Document" knowledge article can be found.
What is Pega
Verbal authorization can only be verified by this person when getting consent
What is the member
The task you use to document any health promotion inquiries.
What is Create General Services Request " Health Promotions"
When members are inquiring about food insecurity and SNAP benefits
What is Second Harvest
Member requesting the balance of their Reward balance
Health Promotion: Viewing a Member's Reward Balance and Card History Knowledge Article
Compression Devices are covered under this benefit category
What is Medical Equipment and Supplies
Members have to renew their Medical Assistance with the State of Minnesota.
What is Annually
True or False - You must offer an appeal to a member even if the claim has been reprocessed.
True
A team made up of representatives from Member and Provider services, providing resolutions for daily and complex issues, electronic communication, and back office work
What is the Customer Delivery Team (CDT)
You may not release:
What is "Confidentiality for Govt Agcy and Care Coordinators"
The task used to document when member calls about their eligibility.
Review Eligibility task
Vouchers ordered through this system
CHIPS
The member is calling about a previous inquiry, and the S-Case is assigned to "CDTWB@FUSE".
Message Center - Member Follow Up