Benefits
What system in CRM is used to quote benefits?
DEBUT
Can we change a PCP that's OON?
No
True or False:
Once verbal consent is obtained, it's good for every call going forward.
False
Verbal consent is only good for that specific call occurrence.
What 2 systems are used to update demographics?
1. CRM
2. CI
Sam is calling to make a premium payment. Which system in CRM would you use to make his payment?
eBilling.
What is a stress test listed under in debut?
Diagnostic Testing
What system is used to verify if a PCP is INN?
Physican Finder Plus (PFP) & PAAG (if needed)
What pieces of information are needed when obtaining verbal consent from a member?
1. Name
2. DOB
3. Zip Code
4. Consent to speak to the person calling
After how many days do we need to verify an address on file?
90 days.
While making a premium payment, is it necessary to read the terms and conditions every time?
Yes, always.
Hank Hill is having a skin tag removed at the dermatologist, how would you quote this?
Surgery Services
What Classification & Intent is used when research is needed for updating PCP?
PCP Research Requested
Consent form expiration date, is it the same for all states?
No.
Some states have a 12month expiration, others have 24month expiration. Verify in Consent Methods Overview mentor.
What are the 8 types of demographic changes?
Name, Address, Phone number, Email, Medicare ID, DOD (date of death), DOB (date of birth), Gender
What types of premium payment methods do we offer?
Auto Pay: SSA/Railroad, Checking or Savings account, Credit or Debit card.
Other: Coupon Book, Bank bill pay, MyHumana, Phone payment
Walter White is checking his copay for an x-ray, what would you quote in debut?
Basic Radiology
What 3 systems are used to update a PCP on file?
1. CRM
2. DIGBOT
3. CI
Are all POA types able to do the same thing?
No. POA Type O, Type H, Type U, and Type C are all for different things.
Refer to POA Types and Allowed Actions Mentor.
Tyler is calling to make a temporary address change. You see he has a PPO plan; how long can Tyler be Out of the Service Area (OOSA)?
For PPO & PDP members, they can be temporarily OOSA for up to 12months.
Refer to Temporary Address Change Calls for Medicare Members Mentor.
True or False:
Late Enrollment Penalty (LEP) is only a one-time charge.
False. Members pay the LEP as long as they're enrolled in a Medicare part D plan. Members are billed each month along with the monthly premium.
Refer to Late Enrollment Penalty Overview.
Mary Smith is calling to verify coverage for an Echocardiogram (Echo), what would you quote per debut?
Basic Radiology
What template in CRM do you fill out immediately after updating a PCP on file?
PCP Questions Template.
This is located on the right side of CRM once you associate your case.
Members daughter is calling on behalf of her mother who passed last week. Nothing is on file, are we allowed to release information?
No.
For deceased members, we have to have Executor of Estate (EOE) on file before releasing ANY information. Refer to Power of Attorney and Executor of Estate Overview Mentor.
Scenario:
Mukesha moved from Kentucky to Texas, you have already updated the address. What would you do next?
Warm transfer to DMS sales department to get Mukesha a new plan in Texas.
Why are Late Enrollment Penalty (LEP) assessed?
-Had a gap in credible coverage for 63days or more.
-Didn't enroll in part D coverage during initial election period.