Acronyms and Definitions
What is PDP?
Prescription drug plan.
What are 2 states that cannot enroll with ambetter?
CA-NY
What kind of information is included in the PII?
Name, address, birthdate, nss
What is the template we use after a call?
-Reasons for call
-Action
-Resolution
Needs approval from the Billing Operations Manager
Refound from $1,000 dollars
FPL stands for what and what is it used for?
Federal Poverty Level And it's used to determine your eligibility for certain programs and benefits.
What are the three Plans of Ambetter?
ambetter balance care, essential care, ambetter secure care
What establishes standards to protect PHI held by these entities and their business associated?
HIPAA privacy rules
What are the Notation Requirments in a narrative text?
Enter one note telling the story of the call in "Final call summary"
Name the status when the Initial payment is received?
Enrolled Status
Define Health Plan
The Package of programs and services contractually agreed between the state and a MCO
Ambetter has you covered with plans in how many states?
20
When a citizen reluctantly makes an informal payment in order to receive medical care, which would be refused otherwise, she’s nevertheless committed what type of bribery?
ACTIVE
What is the Omni?
It is the platform where we receive the calls.
Mention the two options of the invoice schedule?
initial invoicing and monthly invoicing
What is a whistleblower?
A person who exposes activity deemed illegal and violates professional and clinical standards
Brand Name for Centene in CA
Health Net
Name 2 types of corruption and the definition
Active : offering someone a benefit in order to influence a decision or in exchange of a benefit
Passive: accept or receive a benefit in return for using ones influence to affect a decision
Why it is require to make a register after every call?
Because it helps your peers assists members on future calls and protects you and the company
Two main impacts of being eligible for APTC?
how long the grace period is and how a claim is adjudicated
A tax credit you can take in advance to lower your monthly health insurance payment (or “premium”). What Is this referred to as?
APTC
what are 3 things the ambetter MYHEALTHPAY'S reward plan covers?
monthly premium payments, transportation, Dr.copays
Who Encouraged healthcare providers to adopt electronic health records and improved privacy and security protections for healthcare data…?
HITECH
Describe the steps you have to make in every element of the narrative text:
1.Reason for call:
-Why did the caller call? -Must include every reason the caller brings up or discuss
2.Action
-Here we describe the steps we took to assist the caller -Where you found info if outside of Omni
3.Resolution:
-Here we record how the issue was resolved
-We must close our conversation making sure the caller has no further questions
-End each "Final call summary note" with: Caller had no further questions and understood
Tell me the steps in the "pay later" initial payment?
application submitted, pay later , invoice mailed, payment made, monthly invoicing