BSC Systems/Tools
What is Facets?
This column on the group grids chart will tell you if you are enrolling a direct pay or a standard pay member.
What is Column J: Type?
A member has this many days to request to change their PCP. After this number of days, the request is forwarded to the PCP Process Request email box.
How many is 30 days?
T/F An ENTS certificate needs to be sent for a subscriber moving from a Basic PPO plan to a Medicare Supplement PPO plan with a New Sub ID
What is False?
This is considers a plan transfer not a true termination.
Any changes/updates/actions taken on an account, this step is present.
What is adding notes?!
The primary system used to verify CalPERS member eligibility.
What is myCalPERS?
Enrollments are completed in this Subscriber Family Application.
What is Enrollments?
When updating the Payroll Office Code during Member Maintenance, until the DLP is updated we must remember to follow this process instead of changing the current occupation code's Effective Date.
What is Add a termination date and reason to the current Occupation Code on file and Add the new one.
Dependents should be canceled at this level.
What is on the Member Level?
What is 30 Miles?
This tool is used to verify if a member's chosen provider is compatible with their plan and within their service area.
What is Find a Doctor?
No Welcome Kits should be sent out to these enrollees.
What is 120 Day Survivors?
31MD Enrollment request must come from one of these two departments.
Who is Utilization Managment (Medical Care Solutions) or Claims.
A policy that is reinstated with no lapse of coverage should be reinstated with this date.
What is the day following the termination day? (ex. TM 7/5/2025, the RI 7/6/2025)
What is Saved Letters_Not Printed?
In the Sharedrive: IM_PHI\CalPERS Service Team\Installation & Membership\PRINTED LETTERS\Saved letters_Not Printed
This tool is used to locate members subgroup and class ID using information found in myCalPERS.
What is the Group Grids Spreadsheet?
You access this DLP during the Enrollment process for the steps on adding the CalPERS Member ID Attachment.
What is Notes and Attachments-CalPERS?
If a CalPERS PPO member lives outside of California, we will assign a PCP in Facets through this process.
What is Using the OOS Placeholder PCP ID OOSPPOPCP001
Dependents who turn the age of 26 should be terminated with this date.
What is the first of the following month of their 26th Birthday?
These are the 4 steps you will take to cancel an ENTS certificate.
Double click on subscriber> Select Auto Actions> Highlight the ENTS Certificate> Select Delete
The only three reasons you would use Edifecs as the source of truth.
What is...
Viewing address on Future Enrollments
Viewing full Social Security Numbers
Checking Payroll Office Codes R or S (Direct Pay Members)
When enrolling Combo/Split Plans this product will always be added to the Medicare Supplement Members but appear as No in my CalPERS.
What is Vision?
Remember Vision is only added to the Medicare Supplement Plan, it should NOT be added to the members in the basic plan and Dental is also NOT offered to CalPERS members although it may show as Yes in MyCalPERS (this is typically through another carrier)
This is an important Mandatory action if a member transfers from a Direct Pay to a Standard pay policy.
What is inputting a termination date on the Rate Data and leaving the Billing Entity as it is?
Note: If an additional address is at the billing entity level for 120 Day Survivor, it is mandatory to remove it.
If cancelling a duplicate account NIF (Never in effect) you must do this on the account.
What is Remove the SSN?
The waiting period for CalPERS and CCPOA groups.
What is 0 Days?