Go Call Foundation

To call or not to call (Call Overview)

100

How many MAIN call types did we learn about?

8 

Authorizations

Enrollment

Benefits

Providers

Claims

Pharmacy

Demographics

Web portal/App

200

What are the three C's?

compassion, customer service, call ownership

300

In the video "The Headset", why was the child's medication denied?

The provider did not show medical necessity.

400

Which call type falls under this scenario:

“Can I update my address?” • “How do I update my email address?” • “I need to add an authorized representative to my account. Can you do that?

Demographics: Involve updating or gathering member information: 

500

What term is used throughout this training to refer to various UHC customer service roles?

ADVOCATE-We will use the term
"advocate" throughout to refer
to the various customer service roles within UHC.

reMEMBER that (Our Members)

100

What does CMS stands for?

The Centers for Medicare & Medicaid Services (CMS)

200

_____________is a joint federal and state health insurance program for people with low incomes. Pregnant women, children, the elderly and people with a disability may qualify.

Medicaid-is a joint federal and state health insurance program for people with low incomes. Pregnant women, children, the elderly and people with a disability may qualify. 

300

How many different plans are offered in HI? Name them all?

4

Hawaii QUEST Integration Plan (CHIP 

Hawaii QUEST Integration Plan (TANF 

Hawaii QUEST Integration Plan (Medicaid Expansion 

Hawaii QUEST Integration Plan (LTSS

400

What are some qualifications that make a member eligible for Medicaid?

Income level, being a child in foster care, people with disabilities

500

What types of medical services are covered by Medicaid?

• Hospital stays, preventive care, doctor visits, tests and x-rays, etc

Did You Know? (DSNP Basics)

100

T/F: DSNP- people who qualify for both Medicaid and Medicare. 

TRUE

200

What does DSNP stands for:

DSNP (Dual Special Needs Plans)

300

What are the two main qualification options for Medicare?

Over the age of 65 OR under the age of 65 with certain disabilities/illnesses

400

What are the different types of Medicare coverage and what do they cover? (I'll accept 4)

• Medicare A - Inpatient hospital care
• Medicare B - Outpatient care, office visits
• Medicare C (Medicare Advantage) - Combines coverage for Medicare parts A, B and sometimes D
• Medicare D - Prescription medication coverage
• Medigap (Medicare Supplement) - Covers costs not covered under parts A or B

500

T/F-Medicaid is the primary payer?

False: Medicare is the primary payer for DSNP plans

You Name It

100

______ outpatient care including doctor visits and lab work is covered under Medicare Part?

Medicare Part B

200

This insurance type is available to people who don't have coverage through an employer, Medicare, or Medicaid.

IFP-Individual and Family Plans

300

What does C&S stands for?

Community & State

400

What are the 6 systems you will need to pull daily while in training and production?

Systems you will need to pull daily while in training and in production

•Paylocity: Company ID: 306343 https://login.paylocity.com/Escher/Escher_WebUI/employeeselfservice/home/index

•Omnicare Teams

•Omnicare Email (Outlook)

•Citrix: https://mytraining.optum.com

•UHC/Citrix Teams

UHC/Citrix Email (Outlook

500

What are some medical conditions that may qualify a person for Medicare?

I will take either one or both (ALS OR ESRD)

Um, Do I know you?

100

Who is a wedding DJ in our class?

Ronald

200

This person is in our class and runs marathons? Can you name who this is

Suzette

300

Name someone in our class who loves playing pickle ball?

Milika (lika)

400

Who is a foster mommy to puppies?

Bobbi Ayn

500

This person loves to compose music. 

Kevin