Benefits
What is Continuity of Care
Makes sure that health care isnt disrupted when a provider terminates
In Order to Release PHI what is needed?
Must be an Authenticated call and Verbal Consent and Consent of file, POA on File
What is the 3 Stages in RX
Deductible
Initial
Catastrophic
Where do we access the template to start an Demographics Change...
Associate to policy and use the Update Plan Demographics Process link
What is the name of the Mentor Document when member call in and Say I got a letter that my PCP has been Terminated
Provider Termination calls
What must be clicked to create an Interaction when a call is authenticated?
Click save on the Interaction Log
What is the Copayment for Insulin?
35%
If it comes back as OSA! What is the process to help the member
Inform the member that the plan will terminate at the end of the month due to Out of Service area and transfer to DMS
What Additional Benefits should be offered to callers when quoting surgery benefits
Anesthesia and Diagnostic Testing
What information can be Provided when an call is Unauthenticated ?
General Information that is not Member or Plan Specific
What is this years Maximum Deductible
$615
Are we allowed to change Name /Gender in CRM . Explain
No - These must first be verified in Wipro and then SSA will do these changes if Different
Give examples of DME
Wheelchairs, Hospital Bed, CPAP etc
To Authenticate a call what elements are needed?
Member ID
Zip Code
Date of Birth
PID
What Mentor Document do we use when the drug is Not in the formulary list?
Tier/Drug list exception Overview
What must be done every 90 days?
Verify Demographics
What Information is displayed when clicking cost and deductablies in Debut
MOOP, Deductibles, Premium and Part B Waiver
When an caller comes in other than the member and the member has had an stroke, what mentor process should be followed?
Special circumstances mentor document in HiPAA overview
What mentor doc do we use when there are denial codes in RX Call Connect
Actions for RX error codes
How long does it take for Mailed communications
7-14days