Demographics
What demographics must you verify in Wipro before making any changes?
Name, DOB, DOD
What 2 systems can you load Find Care from?
CRM and Debut
Which mentor document is best to start in for a benefits verification call?
Verification of Benefits Table of Content or Verification of Benefits Medicare Overview
If a member would like to pay their premium for the full year, can they? True or False
True
What is the time frame for AEP?
Oct. 15th - Dec. 7th
What POA Type must a mbr respresentative have before they can make a demographic change?
C, H, or O
What class and intent do you use when locating provider's for member's?
Provider/locate
What detailed information could verification of benefits entail?
Copays, Coinsurances, Deductible, Any enhanced or additional benefits, MOOP, IN and OON benefits if applicable, Preauthorization or referral requirements
What is a late enrollment penalty?
A penalty assessed by Medicare if member doesn't enroll in a part d plan when first eligible and have a gap of 63 days or more.
What are the election periods?
Annual Enrollment Period (AEP), Open Enrollment Period (OEP), Special Election Period (SEP), Initial Coverage Election Period (ICEP)
When a member is deceased what replaces the POA?
Executor of Estate
If we tell a member that a specific provider is not in network and they insist they are what other system can we utilize to verify?
PAAG
What tool do you utilized to quote benefits?
Nexus formerly Debut
What are the accepted credit or debit cards for premium payments?
VISA, Mastercard, Discover or American Express
What is the call type that you receive that you must reply yes to?
CMS test call
How long is a member with a PPO and PDP allowed to be temporarily out of the service area with an address change?
12 months
If a message about Centerwell/Conviva Services show up in find care what are we supposed to do?
Click on the banner and relay the information to member to see if they would be interested in utilizing one of those providers
If a member calls about a fitness benefit what would you search for?
Silver Sneaker's
What is the grace period for a pdp plan on premiums?
3 months
What is the document Humana mails out in September called to show upcoming changes to a plan for the new year?
How long are any of the rest allowed to be temporarily out of the service are?
6 Months
When locating provider's for a member, should we offer to call the provider office and schedule an appointment?
Yes
If a member has a medical deductible, do they have to meet the deductible before the plan kicks in and helps with coverage?
Yes unless there are exclusions to the deductible
True or False: Medicare Advantage (MA) or (MAPD) have a grace period for late premiums?
False
If you have to get an interpreter on the phone for a member what is your pin number?
1441