MEDICAL
PARTS OF MEDICARE
WHAT IS PARTS A AND B?
THE PART OF DRUGS
WHAT IS PART D?
THREE MONTHS BEFORE AND THREE MONTHS AFTER MEMBER'S BIRTHDAY
WHAT IS INITIAL ENROLLMENT PERIOD (IEP)?
MEMBER WANTS UHC TO COVER A HIGHER TIER MEDICATION AT THE COST OF A LOWER TIER
WHAT IS TIER EXCEPTION?
SOMETHING YOU MUST FOLLOW WITH EVERY CALLER
WHAT ARE HIPAA GUIDELINES?
CAN BE LEVEL 1, 2, OR 3 TO DECIDE WHAT COPAY MEMBER PAYS
WHAT IS LIS?
ANOC
WHAT IS ANNUAL NOTICE OF CHANGE?
10/15-12/7
WHAT IS ANNUAL ENROLLMENT PERIOD (AEP)?
MEMBER WANTS UHC TO COVER A CERTAIN QUANTITY OF A DRUG
WHAT IS QUANITY LIMIT?
COMBINES PART A AND B WITH EXTRA BENEFITS
WHAT IS PART C?
STATE RUN PROGRAMS THAT PROVIDE FINANCIAL ASSISTANCE TO HELP PAY FOR PRESCRIPTION DRUGS
WHAT IS SPAP?
DMR
WHAT IS DIRECT MEMBER REIMBURSEMENT?
1/1-3/31
WHAT IS OPEN ENROLLMENT PERIOD (OEP)?
UHC REQUIRES THE DR TO SEND THIS FOR CERTAIN DRUGS FOR MORE INFO TO ENSURE A DRUG IS BEING USED CORRECTLY FOR A MEDICAL CONDITION COVERED BY MEDICARE
WHAT IS PRIOR AUTHORIZATION (PA)?
FIRST NAME AND LAST NAME AND DOB AND, MEMBER ID OR ADDRESS
WHAT IS MEMBER VERIFICATION?
MEMBERS PAY A SET AMOUNT BILLED BY UHC INSTEAD OF PAYING AT THE PHARMACY
WHAT IS MEDICARE PRESCRIPTION PAYMENT PLAN (M3P)?
DME
WHAT IS DURABLE MEDICAL EQUIPMENT?
PLAN START DATE OF 1/1
WHAT IS ANNUAL ENROLLMENT PERIOD (AEP)?
REQUEST FOR THE DRUG TO BE COVERED AFTER BEING ADVISED OF BEING NON-FORMULARY
WHAT IS FORMULARY EXCEPTION?
A DETERMINATION REGARDING PART C BENEFITS, PAYMENTS, OR THE TERMINATION OF HEALTH SERVICES TO WHICH THE MEMBER FEELS ENTITLED
WHAT IS ORGANIZATION DETERMINATION?
A DETERMINATION REGARDING A MEMBER WANTING A CERTAIN DRUG COVERED
WHAT IS COVERAGE DETERMINATION?
LEP
WHAT IS LATE ENROLLMENT PENALTY?
PLAN START DATE OF 1ST DAY OF FOLLOWING MONTH
WHAT IS OPEN ENROLLMENT PERIOD (OEP)?
UHC WANTS MEMBERS TO TRY A GENERIC VERSION BEFORE COVERING BRAND
WHAT IS STEP THERAPY?