Show:
Enrollement
Disenrollment
Cancellation
UM
Workflow
100
What is the application date for SPAP enrollment requests during the AEP?
October 15
100
A group member can disenroll directly with the plan.
True
100
Of the three methods a member may use to disenroll, which can the PDP cancel?
Submitting written intent to the PDP - by fax or mail
100
What is your standard blue note?
date/pend for obc/ initials additional information 05/14/2015/ pend for obc/ic all databases match. no residential phone # or rx information found in peoplesafe.
100
What workflow tool houses returned Residence Verification Forms and is used by the Quality Verification Team to score task accuracy?
MedForce
200
What is RDS?
Retiree Drug Subsidy
200
The group's open season is March-May. The plan receives a signed disenrollment form from the member on December 2nd. What do you do?
Disenroll the member effective 01/01
200
. If the member's Legal Rep called Care to cancel the May 1st enrollment on April 30th, and the routed call was lost until May 20th, what will be processed?
Because the request was received prior to the effective date, a cancellation can be processed
200
If you add a new address to you have to turn on the class in facets?
yes
200
Which system was designated as the “Heart”?
facets
300
What would be the application date for a group enrollment?
1st day of the month prior to the effective date of enrollment
300
What coding distinguishes a member as being in an employer/union group plan?
PBP 801
300
The member's disenrollment effective date is June 1st. The member requested cancellation by telephone to Customer Care on May 31st. The transmittal form was scanned into MedForce on June 6th. How should the task be processed?
Cancellation of Disenrollment effective June 1st
300
If you find a new address in marx but their is no phone # in facets, do close or pend the case to verify the new address?
close
300
Which system does not have some sort of queue or workflow process for users to obtain work or tasks? MedForce Fazal Facets Pega Valencia
facets
400
Mrs. Taggert submitted an enrollment to us on 9/13/2013. Her enrollment form shows she became entitled to Med A & B on January 2006. She indicated on her enrollment form that she currently lives in a nursing home. What is her effective date?
10/01/2013
400
If during reconciliation, it is found that the group member has died and the spouse has incorrectly been receiving benefits for 2 months, can the group disenroll the spouse effective the same date of the group member's disenrollment?
Yes
400
While speaking with the member on your recorded line after the disenrollment effective date, he/she asks to re-enroll. How can you assist?
You can give the member the number to Customer Care
400
If the current or new address in OOA but there is no phone # for member or rx information in peoplesafe. Do you pend or close the case?
Pend 05/14/2015 PEND FOR OBC/IC NEW ADDRESS IS OOA. NO RESIDENTIAL PHONE # FOUND OR PHARMCY INFORMATION IN PEOPLESAFE. send sub id to the obc team for an outbound call.
400
What is the last application you check when lookin for a new address?
peoplesafe
500
If the individual is eligible for more than one enrollment period, but does not indicate an effective date on the enrollment, and there is no phone number to make an OBC, what do you do?
Give them the earliest effective date
500
If an incomplete disenrollment request was received without a signature on April 20th and a secound-but complete-reqiest wa received on May 4th, what is the application Date & effective date?
April 20th, and may 1st
500
When submitting a Cancel Disenrollment? (CXLD), the effective date is the same as the effective date of the disenrollment.
False
500
what format would you use when you add a new address that is foreign?
• Mail address line 1: Enter the street address or post office box number. • Mail address line 2: Enter the city or town name, other principal subdivision (such as province, state, or county) and postal code (if applicable). Do NOT enter any information in the address line 3 • Mail Zip Code field: Enter 99999. • Mail City field: Enter full country name. • Mail State field: Enter FN.
500
What applications are used by UM?
Medforce Marx Facets Peoplesafe Valencia