Better Care, Better Value
(KM1007763/KM1866001)
(KM1007763/KM1866001)
Full VBC and Split VBC
What are the the two types of VBC arrangements
Employers may choose to pay the entire premium or part of the premium.
What is subsidized.
Name the team who supports a member through their denture journey
What is the Specialized Denture Support Team
Attempts made to members by phone call, text, and letters.
What are member outreaches
How to handle difficult situations
What is the Situational Guidelines - Index KM1004126
A set payment amount Per Member Per Month (PMPM) with financial risk falling on the providers.
What is Capitation
These retired employer groups are serviced by a dedicated team.
What is high profile employer groups.
Name the coverage for dental services such as exams, cleaning, and x-rays.
What is routine dental coverage
Housecalls visits are especially effective for members who struggle with this
What is getting to the doctor's office
Support for various timeframes Medicare consumers needing to enroll in a plan.
What is the Election Periods - KM1220956
Claims processing and utilization/medical management (authorizations)
What are the two primary functions assigned to VBC Medical Groups by UHC
800 series, endorsed, National PPO, subsidized, and connector models plans
What are employer group types.
Optional benefit coverage that can only be added during AEP or within the first 3 months of a new plan's effective date.
What is a dental rider.
ID# 931380123
Check eligibility
What is not eligible due to member refusing
Outlines measurements used by CMS to measure member experiences and satisfaction with their heath plan.
What is the Annual CAHPS and HOS Surveys Index KM1004845
Using what tool: Group #91038; 2026
1. Provide the delegated entity
2. Are claims; prior auths; referrals delegated
PST tool:
1. Optum Health Networks
2. Yes
Using what tool:
IBM employee with NPPO/Essentials Plan needs to see a podiatrist and wants to know the INN and OON copays
GRIF:
What is $50 for both INN and OON
Using "uhcdental.com": ID# 988360095
1. CPT Code description D1206
2. covered or not covered
3. frequency limitation
1. fluoride treatment
2. covered
3. 2 per 1 plan year
Housecall Eligibility Check: ID# 980860358
1. When was the last visit?
2. When can the next one be scheduled?
3. What if member requests sooner?
1. 02/16/2026
2. Around same time as the prior year (around 02/2027)
3. Contact Housecalls team
Using what tool: Group #90875; 2026
1. Delegated entity
2. The claims address
3. Electronic payer ID
PST tool:
1. Optum Health Network
2. P.O. Box 30539, Salt Lake City, UT 84130
3. LIFE1
BNA Salaried employer group name and dedicated phone number
Using AKA list:
What is Boeing 877-714-0178
ID# 913583650
1. Vision vendor
2. allowance amount for frames or contact lenses
1. What is United Healthcare Vision
2. $300
Tool used to schedule Housecalls: ID# 913583650
Complete a demonstration
PCSS tool
1. Age (65yrs or older)
2. Disability
3. End-stage renal disease or ALS
What is General Medicare Eligibility KM1732103