Random things to know
Content manager is for what use?
Seeing letters or forms received or possibly sent to and from members or providers
Per Misource Article "denied claims" how should you first review the claim?
Check event code, C.E even, Event List, and Notes
We follow_____
Medicare Guidelines
Annual Enrollment Period & Open Enrollment Period
What plan had silver sneakers newly added for this year?
Mpsers
When you make an outbound call what verifications do you need to complete before giving information
Name, DOB, and address
539 means what kind of denial?
Timely Filing
SOM has their PDP with who?
Optum RX
What are the dates for AEP and OEP
10/15-12/7 & 1/1-3/31
What new benefit did URMBT gain?
OTC
Are we able to locate an enrollment application, if so where?
Ika Gateway
What is the difference between a UB claim and a HCFA claim
UB is a facility claim. HCFA is a physician claim
URMBT can have UP to how many accumulators
5
If I were a caller needing an explanation on LEP how would you describe it?
LEP is a Late Enrollment penalty that is applied to your premium when there has been a gap in credible prescription drug coverage for 63 days or more. This can follow you for the rest of your life
Who is the new OTC vendor
Convey
If a member wants to sign up for mail order what number do you give?
MA resource list 866-877-2392
if a provider ends in 01 vs 02 what is the difference?
01 is in-network 02 is out of network
If a member had hearing aids previously with another plan but not with us, would they require a medical review?
YES
Can you transfer a member to gohealth to sign up for the supplemental benefit package if its during AEP or OEP
NO, they will ALWAYS need to fill out a form. They cannot sign up over the phone
The new requirement for at home testing coverage applies for Medicare advantage members, true or false
False
Can you run a test claim for a prescription drug, if so how?
RX tool in ncompass
If a pharmacy wants to bill for a Part B immunizations what ability do they need to have in order to bill properly?
The pharmacy must be able to submit a HCFA 1500 form for a 837 submission
If the silver sneaker benefit is not covered in the EOC what is an alternative resource you can provide to the member?
Blue365
How many days from the effective date does the member have to add the supplemental benefit?
30
Generic questions will start off in these calls "can you answer questions about part C?" "Are you able to provide general information about Part D?" What type of calls are these?