How many one-way rides are the DE DSNP member's able to receive?
Routine transportation for up to 24 one-way transportation trips per calendar year.
100
What is the name of the Delaware state eligibility system?
DMAP
100
Are members enrolled in DE DSNP eligible for case management?
All members have access to care management; the process used depends on the member's plan and the member's individual needs. The plan's approach is to overcome gaps in care that results from individuals with chronic health conditions.
100
What is the name and contact number for who provides hearing services?
EPIC Hearing Health Care 1-866-956-5400
100
Member's are covered for glasses until what age?
They are covered age 20 and younger
200
How often are DE DSNP members able to get routine eyewear or contact lenses?
Every two years
200
Which system would you use to assist a member in finding local resources not covered through UHC?
Healthify
200
Where would you transfer a member to if they do not have an assigned case manager, but would like one?
Warm transfer the member to Care Management at 1-855-821-9102
200
What is the name and contact number for who provides transportation benefits?
Logisticare - 1-866-418-9812
200
Where can we refer a member who calls in and wants to know where their Logisticare driver is?
Where's My Ride: 866-896-7211
300
How much is a member given per quarter for the FirstLine Medical Health Products Benefit catalog
$130 per quarter
300
What is the name of the new system you will use to search for appeals and grievances?
MIIM
300
How would you get a DE CAID or CHIP member assigned to a case manager if they did not already have one, but are requesting to have one assigned?
Complete the HRA in icue
300
What is the contact number for DE Medicaid?
800-372-2022
300
Where would you direct a member who is age 20 or younger looking for their dental benefits?
Age 20 and younger: Covered by Delaware Medicaid. Give basic benefit information. Warm transfer to 1-800-372-2022 for additional information.
400
What are the four ways a member can be disenrolled from the plan?
1. Complete and submit a disenrollment form. Member can obtain the form online at Medicare.gov.
2. Submit a written disenrollment request.
UnitedHealthcare
Attn: Community and State Medicare Enrollment
4316 Rice Lake Road
Duluth, MN 55811
3. Enroll into a different Medicare Advantage plan
4. Call 1-800-MEDICARE (1-800-633-4227) 24 hours a day, 7 days a week to receive information on alternative plans available.
400
What system do you use to locate a case manager?
icue
400
Where do you navigate in iCue to find a members assigned case manager?
Member drop down, select programs, program history
400
What is the number you would refer to if a member's address needs to be updated, and is incorrect in the state eligibility system?
Change Center - 302-571-4900
400
A & G - What cannot be escalated for DE members?
Grievance
500
What are the pharmacy copays for the members (both generic and brand) if the member does not qualify for assistance through Medicare part D
For generic drugs either:
- $0.00
- $1.20
- $3.30
- 15%
For all other drugs
- $0.00
- $3.70
- $8.25
- 15%
500
What information will you need in order to search for a member in the state eligibility system? (two answers, we will need both to get points)
Either the Medicaid ID number, or two of the following: name, DOB, SSN
500
Who would you transfer a member to if they have the correct contact information for their case manager, but they have not been able to reach them?
Warm transfer the member to Care Management at 1-855-821-9102
500
What is the name and number to where you would refer a member if they are eligible for Medicaid but not enrolled in an MCO?
Health Benefits Manager 800-996-9969
500
What is the name of the program you have to make a member aware of if they call in for a behavioral health provider (age 18+)?