DSNP
How do you activate member's u card?
Verify last 4 of U card and hit activate located next to members name as U card picture.
what visits are always covered for medicaid?
hospital and physician visits
If you forget to select the check mark that member is calling what are the steps to access member's account if the member is calling ?
You can add the member as an AR if they are fully Hippa verified
When provider calls for the status of a claim where would we direct them too ?
Provider line
When your phone is not auto answering what steps do you need to take?
Basic Troubleshooting Steps (BTS): phone issues
1. Log out of UHC Genesys and close the browser.
2. Exit from TP Genesys. (outside of Citrix)
3. Log back into TP Genesys. (outside of Citrix)
4. Log into UHC Genesys.
5. Complete an Outbound call to yourself
a. If unsuccessful, Agent logout of both Gen’s and call HD
b. If successful, move on to step 6.
6. Start taking calls
Where would we direct member if they need to make an online otc order?
Solutran
what are at least 4 Medicaid value added benefits?
Baby ScriptsRewards (Healthy Rewards)Blood Pressure MonitorSimplifiedHealth CoachingSmoking Cessation (Vaping & Tobacco)Healthy First StepsWeight ManagementNurselineWellhop
TenderHeart
How do you find recent work ( cases ) in maestro?
Under recent work tab you can see previous cases that were completed.
What id do we use for language line for an interpreter?
Contractor id
How would we look up an outbound call number for member when they state " it came from UHC" ?
Outbound call toolbox
Who helps DSNP members manage their healthcare needs?
Care coordinator
What are alteast 4 Behavioral health services approved by medicaid?
If member is not showing up in maestro with member id what else can we search to find member account?
First and last name AND DOB
When a member calls with a bill that they were sent that shows they are owing provider and it says EOC , What does this mean and what would we assure the member?
Evidence of coverage, assure the member this is not a bill this is evidence of coverage showing what was done by the provider during visits.
Would member with Medicaid be covered for braces?
If so , why ?
YEs, with PA stating its medically necessary
When member is calling to report suspicious activity on their u card, what would we need to check and Who would they need to speak with ?
Fraud department and recent transactions
How much does Medicaid member receive for completing mammogram and how do they receive reward?
$50 and members will be mailed the gift card.
When can you not schedule a commitment in maestro and why?
on a Friday, we can not follow up with members regarding a commitment on the weekends.
What is at least one reason that is inappropriate to transfer member regarding healthy benefit plus ?
inappropriate Healthy Benefits Plus Transfers
How can member change their mcos for Coverkids tenncare?
TennCare will notify CoverKids enrollees of their MCO assignment and how they can switch MCOs if they wish to do so. Following this communication, the MCOs will send their members a CoverKids welcome kit, information to access a member handbook, provider directory and a membership ID card. Each CoverKids enrollee will have up to 90 days from the effective date (01/01/2021) of their assignment during which they may change MCOs. To change MCOs, enrollees should call 1-800-878-3192.
What if member calls and is very upset that they have to wait 14 business day to retrieve their U card, what is something we can do to assist?
Assure to the member that the standard delivery time would be up to 14 business days if they wanted to access sooner their is a option to retrieve the U care in member UHC app / portal and add to wallet on their phones.
What is the TATS for Prior authorization for Medicaid members?
Tennessee 14 Calendar Days for standard and72 Hours for expedited.
What is health assessment called in icue and when can one not be submitted?
It will be listed under RSA and current year, and if member has completed the Health assessment for the current year.
In 2026 there will be a new program that DSNP members can purchase, what is is called and what are at least 2 services that they provider?
For DSNP members, use this information to answer questions about The Helper Bees program:
Starting in 2026, The Helper Bees is offering in-home services to DSNP members.
Members can purchase the following services through The Helper Bees:
In-Home Services: Includes in-home activities of daily life such as cleaning, cooking, laundry, bathing, and dressing
Weight Management Counseling: Includes nutritional assistance and coaching to support weight management goals
Caregiver Relief: Temporary relief for primary caregiver that includes companionship, help with daily tasks, and light housekeeping
Members can purchase specific aging-in-place items like dressing aids, home safety items, and bath safety items through the program.
When are air ambulance covered for medicaid members?
The member’s medical condition requires immediate transportation that cannot be provided by ground ambulance and a delay in transportation time may endanger the member’s life or seriously endanger the member’s health including:
When ground transport times are excessive (i.e., 30-60 minutes or longer); or
When weather or traffic conditions make ground ambulance transportation impractical, impossible, or overly time consuming; or
When the pickup point is inaccessible by ground ambulance
and
The member’s destination is the nearest acute care hospital that can meet the member’s needs; and
One of the following conditions exist:
Services are requested by police or medical authorities at the site of an Emergency; or
Advanced or basic life support is required during transportation