HIPAA
True or False: An Agent can choose to only provide his/her first name for Agent HIPAA if you receive a screen pop with their information in PCL.
False: Agent must verify Full Name (First and Last Name)
System PHD utilizes to check Medicare and LIS.
MARx
Systems PHD utilizes to check Medicaid.
RPA or State System
A form Uplines submit to have their EDC Downlines appointed in a state.
Add State Request form
Election Period that runs from 10/15-12/7
Annual Enrollment Period (AEP)
True or False: NPN is a valid form of agent HIPAA authentication.
False
A client must be entitled to Medicare Part A and enrolled in Medicare Part B to be eligible for this type of plan.
Medicare Advantage
How long is PTC valid for?
9 months or after it is used one time, whichever comes first.
Time of year (Sept 1 - December 31) where an Agent cannot move uplines but can still move Hierarchy levels within NMAs.
Blackout Period
Election Periods that is a total of 7 months.
ICEP, IEP, IEP2
3 things we can use to verify can caller in addition to their full name
Writing ID, Party ID or Tax ID
A client must be entitled to Part A and/or enrolled in Part B in order to be eligible for this type of plan
Prescription Drug Plan
Document PHD references when referring to both Copay and Premium amounts based on certain levels of LIS.
Extra Help Call Handling Tool
The cost of the EDC Administrative Fee for not selling during the Sales Evaluation Period
$200 as of August 1, 2022
True or False: OEP New can be used to switch plans from a PDP to a MAPD.
False: "Individuals must be enrolled in MA Only, MAPD and within the first 3 months of their Part A and Part B start date"
True or False: Assistants/delegates calling on behalf of a Sales Agent should be treated as the agent/broker once verification has been completed.
True
Per the Medicare Verification document, we are not to retain the ___ in any systems utilized by PHD.
Social Security Number
True or False: We should always inform the agent if a client is not eligible due to CARA status
False - We should never inform the client is not eligible due to CARA status
The 2 ways a Producer can change Hierarchy and the waiting period
Immediate release from NMA - no waiting period
Notice of Intent to Release - 3 month waiting period
Special Election Period that is available 3 quarters a year.
Dual LIS Maintaining
The number of points deducted from QA for missing Member/Agent HIPAA
16 points
Besides MARx, this is another way we can we check Medicare Eligibility
MMV Tool in Jarvis
The 4 counties for AZ verification that make a member fully eligible for the UHC Dual Complete LP only if any of the 3 codes show ACC, ACU and LTC DD DES.
Gila, Maricopa, Pima and Pinal
True or False: Conflict of Interest does not apply to both M&R and IFP.
False
Agents who are dually contracted need to complete 2 COIs
MA/MAPD SEP available when a plan is no longer offered in the area.
Non-Renewing (Contract Non-Renewal)