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Which application portal do you use on the Centers for Medicare and Medicaid Services (CMS) site to help current members or new applicants with questions about eligibility and enrollment? You will need to check and confirm that the information is correct to match our system s information.
Marx
Choose which NextGen system you would use for calls and communications, that helps with support, documentation, and making the call handling process easier?
GPS
system used for clocking your activities throughout the day
Estart
Our system where we can send private Chats and join meetings
Teams
What is a key feature of an HMO (Health Maintenance Organization) plan?
You must choose a Primary Care Doctor and get referrals to see a specialist.
What is the date range for the Annual Enrollment Period (AEP) for Medicare?
October 15 to December 7
When does a Medicare Advantage plan typically start if you enroll during the Annual Enrollment Period (AEP)?
January 1 of the following year
System used to send emails on Aetna side?
Outlook
Why is the Evidence of Coverage (EOC) the best document to use when quoting plan benefits?
It provides detailed information about what the plan covers, and any costs involved
Where can we go to look up procedure codes
Rumba
What is a copayment?
A set dollar amount you pay for a specific medical service or prescription at the time you receive it
Why is it important to document information on Medicare Advantage plan accounts?
It ensures we follow proper workflows and helps with accurate call handling.
What does release of Level I information include?
Basic details and general knowledge
What does release of Level II information include?
Personal Health Info (PHI) like Procedure Codes and Diagnosis
Where system can we use to find benefits and the EOC?
STARS
What is a Medicare Advantage plan?
A private insurance plan that provides Medicare benefits and may include extra services
Who is eligible for a Medicare Advantage plan?
People who are 65 or older, or those under 65 with certain disabilities
Where can you find the Authorized Users for a member account in GPS?
Privacy Restrictions and Authorizations
What is a key feature of a PPO (Preferred Provider Organization) plan?
You can see any doctor or specialist without a referral, but you save money by using in-network providers.
What does "Coordination of Benefits" mean?
Medicare members may have more than one active insurance policy.
What does procedure code 72141 describe when you look it up using Service Code Inquiry?
let check it out
what should you click on to find out what services were provided, the diagnoses, and what benefits were used?
Claim Lines
What is the website that our members can use to see their benefits, print forms and temporary ID cards, and check their claim information?
which NextGen system would you use to see enrollment submissions, disenrollment submissions, and member account changes?
Market Prominence
What is the main difference between a Primary Care Physician and a Specialist?
A Primary Care Physician treats general health issues, while a Specialist focuses on specific medical areas.