Understanding Medicare
Enrollment 101/102
HIPAA
Premium/LEP
Documentation
100
This part of original Medicare carries a deductible for stays in hospitals or when you receive at home health care.
What is Medicare Part A
100
These are the methods for enrollment in Blue Cross Medicare Advantage and Blue Cross Medicare Rx
What is Paper, online, telephonic, and CMS auto/facilitated enrollment.
100
Established in 1996 by congress to protect a member's personal health information.
What is HIPAA
100
This assistance is provided to low income individuals to assist in paying premiums, deductibles, and prescription drug costs.
What is Low Income Subsidy (LIS)
100
Documentation is considered this when these are present: Who was calling, why the person called, resolution to the issue, call activites, information relayed to the caller, uses call history, includes all disclaimers used, task for each subject discussed, appropriate subject and category, accurate but short summary line, good details, and good grammar.
What is Good Documentation
200
What do these 6 things have in common under Medicare: Long-Term care, Acupuncture, Routine Dental, Hearing Aids, Cosmetic Surgery, and dentures.
What is non-covered services
200
The purpose of this letter is to confirm the enrollee request and verify their understanding that enrolling into Blue Cross Medicare Rx will disenroll the enrollee from the Employer Group Coverage.
What is Retiree Drug Subsidy (RDS)
200
This caller can make changes to the account and is considered to have the same power as a member
What is POA (Power of Attorney)
200
This reason can cause a LEP to be assessed to a member in addition to a break in coverage that lasts more then 63 consecutive days
What is did not join a plan when first eligible.
200
This process is followed when documenting in the resolution summary of each task
What is Who, What, When, Where, Why, and How
300
These 4 types of plans are offered under Blue Cross Blue Shield Medicare Advantage.
What is HMO, HMO-POS, PPO, and D-SNP
300
Once CMS confirms an application the new enrollee will receive a confirmation letter including their ID card within this number of days.
What is 10 days
300
This MUST be obtained when a Provider calls and entered in the caller information box of TMG Call
What is NPI/Tax ID, Provider/Facility Name, Phone number (extension if available), First and last name
300
A member on statement billing with premium questions must always be offered these payment options.
What is ACH or SSA
300
These boxes should always match when documenting a task.
What is Status and Reason
400
These plans cover all the benefits of Original Medicare and may cover additional benefits that Original Medicare does not cover.
What is Medicare Advantage
400
This address may not be a postal box as it determines their eligibility in our plans.
What is Home/Physical address
400
Even when a member is deceased, these callers can still receive information as long as it is on file in the Member/Subscriber notes.
What is EOE (Executor of Estate)
400
This is the formula used to determine the amount of a LEP
What is 1% of the national average premium, rounded to the nearest $0.10 multiplied by the number of uncovered months
400
This box must list a department when any documentation is sent to a department for processing.
What is Route Group (Route Grp)
500
Blue Cross offers t6hese 3 different plan types in our 5 states.
What is Blue Cross Medicare Rx, Lovelace Medicare Plan, and Blue Cross Medicare Advantage
500
A closed status/route on a SEP Validation means this
What is the enrollment has been denied and they now must reapply/re-enroll
500
The unintentional release of member specific information to an unauthorized caller
What is Inadvertent HIPAA Disclosure
500
This company is responsible for processing LEP reconsiderations and the decision they make is final meaning it can be appealed or revisited.
What is Maximus
500
This must be completed before ending a call to avoid use of after call work.
What is documentation of all tasks
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