What System/Sharepoint Do We Use?
Find It In Maestro!
*FREE SPACE*
Ugh.. Employer Groups
Utilize Knowledge Central
100
If your Member meets the criteria, and you feel you should do a One-Time Exception (OTE) for a Member, what system do you use to submit the request to?
Jira
100
Please use Member ID:
931163171 Judy Benoit
Does this Member have any Pharmacy Prior Authorization Requests?
No
100
Tell us your nickname!!!
Mine is: TonTon Poowell
100
Please use Member ID:
975257377 Stephen Worrell
Member wants to update his phone number. Can we do this or should we get him to his Benefits Center?
Get him to the Alabama PEEHIP Benefits Center
100
Please access: KM2093500
Read the ALERT section to us, please
Valero group will be moving its retiree members from a Medicare Advantage Prescription Drug (MAPD) plan to a Medicare Advantage (MA-only) plan effective January 1, 2026. Prescription drug coverage will be provided through a standalone PDP administered by Express Scripts.
Compassion Alert: Remember, these members may be experiencing uncertainty as they prepare to transition from UnitedHealthcare coverage to new plans with Express Scripts. Please continue to provide world-class service and support as they navigate this change.
- Open Enrollment Period: October 15, 2025 - November 15, 2025
- For questions regarding Express Scripts, members should contact AmWINS, Valero’s third-party consultant, at 1-877-422-4170.
- Valero has not yet communicated this change to members. They plan to do so in early October through their Renewal Plan documents.
- A sample mailing is not yet available. Once released, it will be accessible via the resource linked below.
- The UHC Plan Guide will not be mailed. Once available in October, it will be posted on UHC’s pre-enrollment site:
- Members may request a printed copy of the MA-only Plan Guide by calling in.
200
What is the name of the system that we use to pull calls for listening?
Qfiniti
200
Please use Member ID:
983563608 Randal Miller
Is this Member a part of a Value Based Care Arrangement?
Yes, Optum Health Network
200
Salty Versus Sweet? Which Are You?
I really cannot choose just one!
200
Please go to job aid: KM1613100 and read this job aid to the class.
Important Call out for IBM Members
200
What tab in the M&R Escalation Index can I find how to Add POAs?
Account Maintenance
300
What is the name of the Sharepoint that we use to submit issues to for handling when it comes to Pharmacy?
Pharmacy OPS Sharepoint
300
Please use Member ID:
983563608 Stephen Worrell
What is this Member's Medical Deductible Amount and has this Member satisfied it?
$240.00 Yes, satisfied
300
Are you ready to take M&R calls?
??????
300
You are speaking with a Member who is a Raytheon Employer Group Member. What is the phone number and business hours for the Benefits Center for Raytheon?
800-358-1231
8:00 AM - 4:30 PM PST Monday - Friday
300
What is the KM number for Unexpected Member Payments in the M&R Escalation Index?
KM1274254
400
You need to update the Medical COB for your Member. What is the name of the system you use to submit the request to?
EnterpriseNow
400
Please use Member ID:
974720327 Kathleen Rowe
Can you tell me if this Member is a part of a Value Based Care Arrangment?
Yes, Wellmed
400
Please Tell Us Your Favorite Halloween Candy!!
Reese's Cups
400
You are speaking with a member who is part of the Lafayette Parish Sheriff Office Employer Group. What is the phone number and name of the person at the Benefits Center they need to speak with if they need to discuss premium rates? What are the hours?
337-236-5660 Leslie Serio 8:00am - 4:30pm CST Monday - Friday
400
What is the KM number for how to fix Dental Eligibility Issues in our M&R Escalation Index?
KM1006391
500
You have a Member who is on the COSMOS claims system, and they are NOT a part of a Value Based Care Arrangement. They sent you their Medical DMR and you have sent it to Backend Filming and have your UFE number. What is the name of the Sharepoint you need to now send your information to?
COSMOS DMR REQUEST SHAREPOINT
500
Please use Member ID:
977376066 Nicholas Tracano
This Member is no longer effective. Please tell me what his Contract Number and PBP is for when he was active from 01/01/2024-05/31/2024. *Hint* I gave you all a hint about where to find this yesterday....
H0271 014
500
Any Show Recommendations?
?????
500
You are speaking with a Member who is a Paramount Employer Group Member. They have a question about one of their prescription drugs. Who handles their prescription drug coverage and what is the phone number?
CVS Caremark 866-601-9090
500
What is the KM number for the Vision Coverage - Cataract Surgery - Index?
KM1013720