Maestro
What intent would you use to change a members address?
Update Member Address
What do delegation mean?
What is Lis Level 1
3.70 generic 9.20 brand 0.00 deductible
What do Dme mean?
Durable medical equipment
What is the First Fill Rule?
7-Day Supply Limits (Opioid Naïve) (New to Therapy) (Hard Reject): Members who have no recent history of taking an Opioid will be subject to a 7 day supply limits. Also if its the first time you are filling a script on your insurance this 7 day limit also applies
What intent would you use to make a payment?
Make a payment
What is RSS?
Sometimes referred to as Tier 2 rss provide live customer service, rss's primary function is to assist with end to end process so that a members call can be resolved in one phone call
What is cost share?
Cost-share is a term for the way an insurance plan shares its costs with the consumer. The most common types of cost-sharing are coinsurance and copayments.
Is back support chair covered?
Not covered under Medicare guidelines; not primarily medical in nature.
Do you look for a dental provider in Rally?
No you can use myuhcdental.com or uhcmedicaresolutions.com and put in zipcode
What intent would you use to see if the member has otc benefits?
Review medical benefits
What is a prior authorization? (pharmacy)
The plan requires the member or the members doctor to get prior authorization for certain drugs. This means the plan need more information from the doctor to make sure the drug is being used correctly for the medical condition covered by medicare
What is balance billing?
Member being charged over their member responsibility on claim(s).
Where can you find dme providers in rally?
You can find dme providers in rally under places and them medical suppliers
How long is a house call visit?
A house call visit usually lasts only 45-60 minutes
What intent would you use for renew rewards?
general service request
What is a Medicare covered service?
Services covered by part A and part B. All health plans including the United Healthcare Plan must cover all services that are covered by Medicare part A and B
What program do you use to reprint a Eob
Doc 360
How do you find out what is covered under dme?
Dme list and you find the link for the dme list in kc under Durable Medical Equipment List
What is Renew Active?
Renew Active™ is the gold standard in Medicare fitness programs for body and mind -- available with select Individual and Employer Group Medicare Advantage plans at no additional cost.
What intent would you use to update the primary payer on a members account for prescriptions or medical claims?
Update member cob... coordination of benefits
What Do DSNP mean?
Dual Special Needs Plan
How many different claim status are there?
10.... Paid, Pending, Payable, Adjusted, Denied, Encounter, Bill Above, Provider Write Off, Closed, Resubmitted(RSUB)
CGM or continuous glucose monitors are only covered by three DME vendors who are they?
Can you work on accounts starting with 11 or 12
no, accounts starting with 11 or 12 is community and state and needs to be transferred to their corresponding state