Group 1
Group 2
Group 3
Group 4
100

If a Member's ID number starts with 0,4, or 6, Which platform is used?

NICE

100

Member called in to question a bill that was pertaining to her car accident. Where would we transfer the member?

Subrogation

100

What team handles enrollment/disenrollment disputes?

DEC

100

What team is responsible for handling request related to enrollment or disenrollment, and making efforts to retain the member through resolving issues and providing education?

MRC Team

200

What are the examples of Subrogation?

Accidental injury, slip and fall injury, work related injury or illness, motor vehicle accident

200

What happens to NICE claims when a member reaches claim number 999?

A new member ID will populate

200

Where would we direct a call regarding subrogation?

Optum: offer to warm transfer

200

What is a quick way to tell in a member's account if the member is deceased?

There will be no age

300

Which platform has a maximum on claim?

NICE

300

Who do we transfer the disenrollment requests?

MRC Team

300

Where would you find if a member is delegated?

PMG tab

300

Who can be added as an authorized representative on an M&R members account without having to send an authorized representative form?

Family member, significant other, spouse

400

which support team should we engage if the member requests to Disenroll, change their plan, cancel application, or reinstate their plan?

MRC

400

Member called in and locked themselves out from Uhc.com, if unable to get in by probing questions, where do we send the member?

M&R Web Support Team

400

Where would you find to schedule transportation?

Review Medical Benefits - Transportation

400

When does a standard PCP change become effective?

PCP becomes effective the 1st of the following month

500

Who schedules transportation for PMG member?

PCP

500

If a member is delegated is it possible for the transportation to be handled through the PCP office, True or False?

True

500

What other resource can you use besides review medical benefits to locate detailed summary of benefits?

EOC/ IBAAG

500

what is one way to identify a Cosmos Value based care arrangement?

Identified by the group# and contract ID/PBP # on the plan tab in the job aid Value Based Care Arrangements - Index