KC
What KC would you use to update/change a PCP (primary care physician)
KM1337800
Search and Assign Provider Intent (DSNP)
KC stands for
Knowledge Central
What types of representatives on a members account can be given detailed information?
Authorized rep and POA/Guardian/Conservator
(A caregiver is not authorized to receive detailed information)
Which systems can you verify Medicaid in?
Maestro, DMEVS. and Marx
What KC would you use to quote general medical benefits?
KM1004158
Quoting General Medical Benefits for Dual Eligible Members
OTC stands for
Over the Counter
What must be verified if the members information is authorized through the IVR system?
First and last- if not the member we reverify the acct
Which system would you use to verify a prior authorization on file for medical?
ICUE
What KC would you use to compare skilled vs non skilled care for a home health benefit?
KM1005979
Benefit Inquiries - Home Health Care (Medicare Covered)
DME stands for
Durable Medical Equipment
Where can you find information on HIPAA compliance and caller types?
KC- Knowledge Central
KM1007482 HIPAA - Index
Which system would you use to see a letter the member has sent/faxed in to UHC?
VIEW
Which KC will have the community and state (C/S) numbers in it?
KM1005373
C&S/IFP/M&R Contact Numbers and Hours of Operation
CMS stands for
centers for Medicare and Medicaid services
What information do we need to be HIPAA compliant when verifying members?
Name-DOB-Address (full, city, state, zip code) Need 2 of the 4
Which system would you use to verify a members benefits for the plan?
Maestro
Which KC would you use for a member who is part of the DSNP cost share where UHC pays as the Medicaid processor?
KM1007236
AL, FL, TX- Cost Share Programs
DSNP stands for
dual special needs plan; dual meaning they have both Medicare and Medicaid
What does HIPAA stand for?
Health Insurance Portability and Accountability Act
Which system would you use to see a members Medicaid number?
DMEVS - gps Medicaid number