UHC JEAPORDY

DSNP

100

Can you see vison and dental claims?

No, you would need to contact march vison and UHC dental to locate claims for the member

200

Who is the dental provider for DSNP?

United healthcare Dental

300

What are is something you need too check as an advocate before submitting an appeal for a DSNP Member? 

• A denial must be on file prior to submitting an appeal or the member must disagree with processing or responsibility of a claim. Canceled cases are not considered denials.

400

What are the types of DSNP plans and how much are the allotted for food/otc? 

• TN-S001 (HMO-POS D-SNP):  $251

  TN-Y001 (HMO-POS D-SNP):  $395

  TN-Y2 (HMO-POS D-SNP):  $283

500

What two system do you use to send DMR forms and what is the TAT for member to receive it?

Maestro, Right away 

Macess, 14 buisness days

CAID

100

What do you do if member's Medicaid plan is terminated? 

Provide the number and transfer to state.

200

Who is the dental vendor for Medicaid members?

Renaissance 

300

Do all Medicaid members have vison coverage if not why? 

no, all Medicaid members do not have vison coverage if they are over the age of 21 they have to go through marketplace. 

400

Does medicaid cover DME? If so what is needed for DME to be covered? 

YEs, as long as a PA is filed and approved.

500

What are three benefits covered under ECF Choices? 

Personal Assistance/Supportive Home Care

Community Integration Support Services

 Independent Living Skills

Family Caregiver Stipend

Community Living Supports

Respite

Community Transportation

Minor Home Modifications

Specialized Consultation and Training

Assistive Tech/Adaptive Equipment

Adult Dental Services

HIPAA

100

What information do you need to properly Hipaa verify member? 

NAme 

DOB 

Street address 

or 

Name 

DOB 

Member id 

200

What do you do if you cant properly Hipaa verify the member? 

You can give member public information regarding their plan.

300

Who are three people allowed to be member AR that are considered family? 

• Aunt
• Brother
• Brother-in-law
• Daughter
• Daughter-in-law
• Father
• Grandchildren
• Grandparent
• Husband
• Life Partner
• Mother
• Nephew
• Niece
• Sister
• Sister-in-law
• Son
• Son-in-law
• Uncle
• Wife

400

What must be authenticated in emergency scenarios? 

• Member information
  • First and last name
  • Date of birth
• Caller information
  • First and last name
  • Relationship to member (e.g., executor, trustee, guardian)

    Tip: In Maestro, check the Authorized Reps field in the Member Details banner to identify any authority.

  • Type of emergency

500

What has to be completed and listed on file by member's attorney stating they handle member's personal affairs? 

Requests for information from an attorney cannot be released without a signed written Authorization to Share Personal Health Information Form.

CALL HANDLING

100

How do you handle an abusive caller? 

If the call continues to escalate and becomes abusive (the caller uses inappropriate language):

1. Remain calm. Speak in a soft, slow tone. Remember the caller is likely upset at the situation and not you personally.
2. Warn the caller you may need to disconnect if their behavior continues.
3. Issue a second warning to the caller if their behavior continues.
4. Disconnect the call.
5. Document the call using your area’s SOPs:

200

What all do you need when reaching out to language line? 

Client id 699565

 

Contractor ID (your UHC contractor id 00xxxxxxx)

 

State Code 43

 

Product code

Caid -61

DSNP-62

300

What are inappropriate scenarios for transferring member to Healthy benefit plus ?

• General information
• Eligibility issues
• Verbal grievances

400

What call handling do you follow when a participating Renew Active Fitness location call on the member's behalf to retrieve conformation for enrollment? 

1. Determine if the member is available.
   • Available:
     1. If the member is on the phone or location staff can put the member on the phone, complete the following actions:
        1. Run the Renew Active Gym Lookup macro to generate a confirmation code.
        2. Provide code to location staff or the member.

500

What do you do if member is calling to request reimbursement for purchase of eyeglasses or contact post-cataract surgery? 

If a member would like to request reimbursement for Medicare-covered eyewear (i.e., glasses or contact lenses after cataract surgery), members have the option to submit the Direct Member Reimbursement (DMR) Form, with an itemized receipt included, either online through the member portal or by mail to the medical claims address on the back of their Member ID card