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KP loves Acronyms
Medicare 101
Plans within KP
General Processes
Election Periods
100
CMS
What is the Center for Medicare and Medicaid Services?
100
This specific insurance (referred to as Part A) covers the following: - Inpatient hospital care - Skilled nursing facility - Hospice - Certain home healthcare - Automatic enrollment at 65 years of age
What is Hospital Insurance? ___ For more information, see Searchlight ___ Home > Medicare 101 > Overview of Medicare > Medicare Plan Coverage Parts > Medicare Part A
100
Applicable to California members only, this plan refers to a brand new enrollee or a previous member that had coverage with Kaiser Permanente at one point. This member has a lapse in coverage.
What is Sold-To? __ For more information, see Searchlight __ Home > Medicare 101 > Plans Within KP
100
From the following list, one of these is an inappropriate RFI reason. - Missing proof of entitlements - Signature page is missign entirely - ESRD question is not answered - Did not mark YES or NO for Advantage Plus - No permanent address provided - Invalid form - Unconfirmed plan intent
What is "Did not mark YES or NO to applying for Advantage Plus?" __ For more information, see Searchlight __ Home > Medicare 101 > RFI Overview
100
Based off of the information provided below, a brand new member is eligible to enroll using this election period for this effective date. Date of Birth: 5/15/1950 Part A: 5/1/2015 Part B: 5/1/2015 Part C: 5/1/2015 Receipt Date: 4/3/2015
What is IEP effective 5/1/2015?
200
EGHP
What is the Employee Group Health Plan?
200
This specific Medicare Plan coverage came into effect in 2006 and is referred to as Part D. - These plans are managed by private companies (like Kaiser Permanente) - Voluntary enrollment - Must enroll directly with the plan, not CMS - Has an LEP - Offers an LIS for those with limited income
What is the Prescription Drugs plan? __ For more information, see Searchlight __ Home > Medicare 101 > Overview of Medicare > Medicare Plan Coverage Parts > Medicare Part D
200
If an enrollment request is received and it is determined that the applicant is not eligible for enrollment at that time due to these two reasons, they will be denied upfront.
What are Out-of-Area (OOA) and out of election period? __ For more information, see Searchlight __ Home > Medicare 101 > Denials > Denial Cheat Sheet
200
To access the Medicare Business Engine (MBE), you must first access this portal from either your desktop or your start menu.
What is the Regional Application Portal?
200
Based off of the information provided below, a brand new member is eligible to enroll using this election period for this effective date. Date of Birth: 12/5/1944 Part A: 6/1/2007 Part B: 9/1/2015 Part C: 6/1/2007 Receipt Date: 7/28/2015
What is ICEP effective 9/1/2015?
300
AEP
What is the Annual Enrollment Period?
300
This number is a unique identification code that is assigned by the Social Security Administration to an individual for the purpose of identifying him or her as a Medicare beneficiary.
What is a HICN (Health Insurance Claim Number)? __ For more informatoin, see Searchlight __ Home > Medicare 101 > Overview of Medicare > Medicare Claimant Status
300
Of all the regions that Kaiser Permanente currently provides services in, this one region offers Medicare Cost plans.
What is the Mid-Atlantic States (MAS)? __ For more information, see Searchlight __ Home > Medicare 101 > Plans Within KP
300
When verifying Group Contracts in Common Membership (CM), we must check for Part D along with these two specific Medicare coding(s).
What are R and W? __ For more information, see Searchlight __ Home > Core Systems > CM > Member Eligibility > Check Group Contract
300
== Eligible for DOUBLE the points === Based off of the information provided below, a member submitted an individual enrollment form and is eligible to enroll using these election period(s) for these effective date(s). Date of Birth: 01/02/1966 Requested Effective Date: Not specified! Part A: 4/1/2014 Part B: 4/1/2014 Part C: 4/1/2014 Receipt Date: 11/3/2015 - Part D is already enrolled in MARx as of 4/1/2014. - Did not move. - Does not have LIS. - Five star has not been used. - Group SEP can not be used here.
What is Five Star (R-SEP) effective 12/1/2015 and AEP effective 1/1/2016?
400
CTM
What is the Complaint Tracking Module?
400
There are five required elements that must be provided for Kaiser Permanente to process an enrollment form. - Permanent Residence Address - ??? - Proof of Entitlements - Signature to the Attestation Language - ???
What is an answered ESRD question and plan choice (intent)? __ For more information, see Searchlight __ Home > Medicare 101 > Enrollment Forms > Required Information
400
Members have the option to add this Kaiser Permanente exclusive product to their MAPD individual plan that allows additional benefits such as dental, hearing, eye wear, chiropractic/acupuncture, or routine transportation.
What is Advantage Plus? __ For more information, see Searchlight __ Home > Medicare 101 > Plans Within KP > Advantage Plus Rider
400
For regions that allow SNP enrollments, we must pay attention to one of three indicators in case of intent for SNP. - ??? - Member provided intent or did not provide intent, however, they’ve marked YES to having Medicaid. - ???
What are members requesting SNP and members attesting to having both Medicare and Medicaid? __ For more information, see Searchlight __ What is member requesting SNP and member attesting to having both Medicare and Medicaid? Home > Business Processes > Eligibility BP's > SNP Enrollment
400
Based off of the information provided below, a member submitted a Group enrollment form and is eligible to enroll using this election period for this effective date. Date of Birth: 4/26/1930 Requested Effective Date: 8/1/2015 Part A: 5/1/2012 Part B: 5/1/2012 Part C: 5/1/2012 Receipt Date: 8/19/2015 Group Stamp Date: 7/29/2015 Part D is already enrolled in MARx as of 5/1/2012. Member has LIS for the current year.
What is Group SEP (W-SEP) effective 8/1/2015?
500
MARx
What is the Medicare Advantage Prescription Drug?
500
To be eligible for a Senior Advantage plan, the application must meet each of the following requirements: - Entitled to Part A and enrolled in Part B and Part D - Not medically determined to have ESRD - Permanently resides in the plan service area - Complete an application by providing the required information - Agrees to abide by the Plan rules - ???
What is an application received during an election period? __ For more information, see Searchlight __ Home > Medicare 101 > Eligibility > Eligibility Requirements
500
The California Care Initiative (CCI) program does not allow new members that resides in the following six counties to enroll in Kaiser Permanente’s Special Needs Plan (SNP). - ??? - San Diego - San Mateo - ??? - Los Angeles - Riverside
What are San Bernardino and Santa Clara? __ For more information, see Searchlight __ Home > Medicare 101 > Plans Within KP > Special Needs Plan
500
When processing a record in the Pre-Enrollment Process (PEP) for a Hawaii member who does not have a Health Record Number (HRN), you must send an ActionGram to this specific group to have an HRN created.
What is the Hawaii Regional Master Patient Index? __ For more information, see Searchlight __ Home > Business Processes > Hawaii PEP and Enrollment Demographics Updates HRN Creation
500
This election period can only be used for a NON-Part D COST plan.
What is S-SEP / Other?