Acronyms
CMS
'I have misplaced my ID card. Can you please send a new one to me?'
Material Request
Covers all Part A and Part B benefits; Provides plan cost-sharing equivalent to cost sharing under Medicare Parts A and B, but may be different for specific services; and includes an annual maximum out-of-pocket (MOOP) limit on total enrollee cost sharing (Deductibles, coinsurances and copayments) for Part A and Part B services.
Medicare Part C
This authorization form grants permission to file an appeal, claim or grievance on a members behalf.
Appointment of Representative (AOR)
Double Points : How long is it good for?
What application is used to communicate with members and notate calls?
CAREConnects
OOSA
Out Of Service Area
A member is highly upset and would like it documented.
Grievance
This is the part of Medicare that covers Doctors and Outpatient Procedures.
Medicare Part A
This is a legal instrument which grants another person the authority to make binding financial and healthcare decisions on the members behalf.
Power Of Attorney (POA)
How does Disenrollment happen?
Voluntary : Member chooses to leave on their own.
Involuntary : Members are disenrolled because they are no longer eligible for coverage.
LOB
Line of Business
Member wants to change their PCP.
PCP Change
What are the 3 P's of being a Good Listener?
1. Polite
2. Professional
3. Patience
This enables a member to have someone else speak on their behalf and discuss protected health information but can not make changes to the account.
Release of Information
What resource do you use to look up Common Issues/Guides?
Double Jeopardy
Central Point
CHIP
Double Jeopardy
Children's Health Insurance Program
'Why do I keep received automated calls from you? Please take me off this list.'
TCPA Revocation
Putting yourself in someone's shoes and seeing things from their perspective.
Empathy
This is a person named under a 'Living Will' to act on behalf of a member.
Health Care Proxy
What year was WellCare Founded?
1985
Double Points : Where are the WellCare headquarters?
IRMAA
Income Related Monthly Adjustment Amounts
Double Points : What is IRMAA?
Member wants an ANOC printed and mailed to them in Russian.
Double Jeopardy
White Glove Process
This occurs when providers bill members for the cost of services not paid by Medicare.
Balance Billing
A Power Of Attorney (POA) is valid for how long?
Until consent is revoked IN WRITING or the member becomes deceased.
What is the LEARN formula?
Double Jeopardy
Listen
Emphasize
Apologize
Resolve
Now