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Can we reset a member’s online account password?
No, we should contact the chat support for the website.
Can we use Doc360 to check member benefits?
Yes, using the Exchange SBC and COC document category.
How many reward activities does the member have to complete to receive the $250 credit? Please mention each one.
Do we handle the Tax forms 1095A and 1095B for On exchange accounts?
We don't, we should transfer the member to Marketplace in order for them to guide the member through healthcare.gov
Which two appeal types depend on the member’s state?
Verbal: we should submit the appeal through maestro appeals/grievances task
Written: Member should send the Appeals form through fax or mail.
Can we assign a PCP using the retro or standard method?
No, we don’t have these options available. If we assign a PCP, it will be effective on the same date the member is calling.
Which materials are we able to send through macess,mention one of them.
QHC Letter
What is the name of the system in which we can check the denial of a prior authorization for medical procedures?
ICUE
What are the three types of status for a pharmacy claim?
1-Paid
2-Rejected
3-Reverse/Cancelled
Can we change a member’s address, name, or gender in the system?
we can't, this changes are made through the marketplace.
What is the name of the task and the tab where we can see the medical claim denial reason?
Review medical claim history and we can check it through service line details.
How many payment methods are available to the member, and which ones are they?
-Online
-Over the phone with an agent
-Mail
-IVR
Is it possible to transfer to a supervisor without a template or sending the request through the Teams channel in Citrix?
No,we should send the template to a support or our team manager so they can make the request for a supervisor.
Can we use On screen entry for make payments?
No,we shouldn't be using this option.
Can we send tax form 1095B form for Off Exchange accounts? if so through which system.
Yes, we can through Doc 360 with the "IRS 1095 B" category and using the reprint option.
How many months of grace period does a member with a tax subsidy have to make a payment?
3 months
Which is the name of the department that process refund for us?
Exchange Sme Line
How Long does it take for credit card and bank account refunds to be process?
Credit/Debit card: 5-7 business days
Bank Account :Up to 30 calendar days
What is a Rebate check?
This happens when the insurance does not cover 80% of the member’s services because they did not use the insurance, and the member receives a refund check for the premium they paid.
what type of doctor's are the mental health providers?
Psychiatrist and Psychologist.
What happens when a member does not make the payment in the second and third month and has a tax subsidy?
Claims will be pended for the 2nd and 3rd month of grace period. Pharmacy claims will be denied and member will have to pay full price until balance of premium is paid.
What is a Binder payment?
Is the first payment required for the member to make their plan active.
What is the timeframe for each payment method to be processed? Please mention each one.
Pay by phone (Payment IVR): 24-48 hours
Mailed:
Mailing time: 10 business days.
Processing time: 5 business days.
Online: 24-48 hours.
Pay by phone (Member Services): 3-5 business days.
If the member did not receive a rebate check, can we request a replacement? If so, how?
We should send an email to MLROPS using a template that includes the member’s insurance information and the check details.
What is the name of the task we use in Doc360 to check whether a member received the rebate check letter?
MLRE EOP