VOCABULARY
What is the cost paid (usually monthly) paid by the member to have a plan?
Premium
What system do we use for documentation?
Maestro
We are advocates for Community and State?
False, we are M&R
What intent do we use to add an AR?
Add authorized rep
What resource do we use to help find answers to resolve issues?
Knowledge Central
Define AWE?
Acknowledge
Willingness
Empathy
What system comes from CMS?
Marx
OEP is year round?
False, Jan 1 - March 30
Search and Assign Provider
What is the TAT for sending out a new id card?
7-10 business days
NPOP
Non payment of Premium
What system do we use to look up Prior Authorizations?
PAS and Maestro
Members can change their plan any time they want?
False, during AEP (Oct 15 - Dec 7), OEP, or Special Election Period
What intent do we use to look up medical benefits?
Review Medical Benefits
Which benefit/program offers more ways to stay fit because it is not just a gym membership; it's a fitness plan?
Renew Active
LIS
Low Income Subsidy
What system do we use to verify Medicaid status?
DMEVS
For HIPAA verification, we must get the member's id, first and last name, DOB, social security number and address?
False, we must verify first/last name, DOB, member id and address when needed.
What intent would we use if a member calls in and they mention that they need help finding food or help paying utility bills?
SDOH (Aunt Bertha/Healthy Lives Website)
True or False: Every plan has optional dental, fitness, passport riders?
False
Define CD and OD as well as what Parts they represent?
CD: Coverage Determination & Part D
OD: Organization Determination & Part C
What system do we check to make sure we will get paid correctly?
Estart
When an NBA shows up on member's account we have to do it?
True
What is the intent we use to look up whether or not a medication is covered under the plan?
Formulary Lookup
On a CAG intent, what additional step do we have to do before hitting submit to make sure we are in compliance?
Post CAG to Compliance 101 Team Room for approval