PLAN INFO
Where can you find the EOC for the members plan?
DSNP: UHC Website by selecting the members plan, scroll down until you see downloabable resources.
Medicaid: UHC Website, select the members plan, select the Members Handbook
What can be sent out in maestro under the member materials intent?
Ucards, provider directory, AR forms, welcome kits, EOC, formulary, pharmacy directory, summary of benefits, DMR forms and ANOC's.
Who is the vision vendor for our plans? Will they speak with the member?
March Vision. They do not speak with members.
What is the annual allowance amount for DSNP members for their vision benefits?
$600/annually with 1 pair of covered glasses, contacts
How much do members with S001 plan get each month in OTC/Food benefits?
$290
What is Medicare part A, B, and C?
Part A: covers inpatient
Part B: covers outpatient
Part C: covered routine care that is not covered by original Medicare.
What ways can a member receive the food form to members?
Send Informative Message intent (email)
Macess (mail)
Verbal Attestation (provider outreach)
Member can go to the UHC website to print out.
Who is our new Dental Vendor?
Renaissance
Do Medicaid members have hearing aid benefits?
Yes, if 21 years of age and younger and has to have medical necessity
How much do members with Y001 plans get each month in OTC/Food benefits?
$336
How long can a member keep their DSNP plan without having Medicaid?
6 months
Who needs to fill out the food form and send back to us?
What are the levels of Medicaid and where can we find them?
QMB+, SLMB+, FDBE, QMB, SLMB, QDWI and QI
DSNP Cost Share SOP
What is the annual allowance in dental benefits for DSNP members?
$5,000
Can we do a case management request if the member is DSNP unaligned?
No, the member has to be aligned and the request has to be submitted under their Medicaid.
What department do you need to reach out to when a member is calling to ask about their plan options?
Telesales
Where can you email a list of providers to a member?
Rally
What information can we provide a member who is calling about TennCare Diaper Benefit?
TN.Gov website. 100 free diapers/month for children age 2 and younger.
How many one way trips are covered by transportation each year?
100
If member has an emergency and has to go to the ER, but they are out of state, will the members plan cover the cost?
Yes, only in emergency situations.
Are our plans HMO or PPO plans?
Our plans are HMO plans. HMO plans can only see INN providers. OON providers are not covered unless pre-authorized with a referral. PPO plans can see OON providers and have covered services.
What website do we use to find mental health/behavioral health providers and facilities?
Live and Work Well
Can we file a grievance for a Medicaid member without their consent?
No. Medicaid member must ask us to file the grievance for them.
What is our fitness/gym benefit program for DSNP members?
Renew Active
Are members covered for telehealth/virtual visits?
Yes, as long as their INN provider offers the telehealth/virtual services.