Work Que Operations
Before pulling a work queue item, what button must always be pressed?
What system houses most MA/MAPD and PDP plans?
What is GPS
Name one of the three ways to search for an application in GPS.
Member Search, Work Queue, Application Search.
Where in GPS do you document contacts?
Add Contact History
When may a member request reinstatement or cancellation retraction?
Prior to the effective date of the plan
What icon assigns the WQ item to you?
What is the hand icon
How long can it take for faxed applications to load into GPS or VIEW?
What is Up to 3 business days
Which GPS section shows Welcome Kits, ID cards, and letters?
Fulfillment Requests.
Which dropdown values must always be used for PES notes?
Broker, Enrollment, Membership Status, Application Status, Satisfactory Call Completed.
What TRC/TTC code pair indicates approval of enrollment?
What is 11/61
If a WQ item is already "assigned" what must you do before making updates?
What is ask an analyst if it can be reassigned
Name one reason an application might remain in the GPS Work Queue.
What is unable to verify MBI, or address; a household cannot be created in these instances
The Plan Summary section shows what key details?
Effective date, termination date/reason, contract/PBP.
What must every GPS note include?
SR number, contact info(if caller is contact), agent name, summary of call and your MS ID
In GPS, where do you view CMS transaction history?
Plan Summary Line -- CMS Transactions -- TRR History
If you forget to unassign an item in the WQ after saving draft, what happens?
What is it stays assigned to you
True or False
Jarvis Enroll submissions load into GPS almost immediately?
What is True
Which tab do you use to check the Agent of Record (AOR)?
Update tab under the plan timeline.
If an application is denied and not attached to a Household, where should documentation occur?
On the Service Request in PCL
Name one disenrollment reply code used for CMS cancellations.
13-51
14-51
15-51
What field must be set to blank when returning an item to its original queue?
What is "Assign To"
What is the benefit of opening an application through the GPS Household rather than Work Queue?
Only one note is required, and the footprint is recorded
What should you do if multiple plan timelines exist?
Check AOR for EACH timeline
What must NOT be done for SNP plans?
Do not press "Save"—they require enrollment verification first.
Does PES Tier 1/Generalists process reinstatements?
No, Member Services handles reinstatments