GPS
What does GPS stand for
Guided Personal Service
Name a system we use to view documents Mbrs send to us by mail or fax
IOP/ECHS & CWAS
How old does a MB have to be to get Medicare
65 or under 65 with Certain Disabilities or ESRD
What resource other than GPS Knowledge Articles do we use for policies and procedures?
E.Policies
When validating a members account, what do you select for case origin?
Phone Inbound
Before exiting GPS what two things must you do first
Complete SR and put a comment
How to find what Broker is listed on members account?
Search Market Prom to get NPN/TIN and them use Broker QuickBase to get name
When is IEP and how long do they have
3 months before their 65th birthday, month of their birthday, and 3 months after their 65th birthday/ totaling 7 months
Where can you find links to many different systems you would use in one convenient place?
NextGen Wikitool
What is LEP and where does that charge come from?
Late Enrollment Penalty/ Medicare assesses for going longer than 63 days with no Rx coverage
Where do you find Medicare ID # and effective dates
Medicare Attributes
What system do we use to mail disenrollment form to MB?
OBC
Charlie Crunchy is dissatisfied with his plan and wants a new one but he used his SEP to move into this new plan last month. What do you tell the MB? The date is 11/8/24. Be specific if there is an election period they can use.
Provide empathy, advise of AEP timeframe, transfer to Telesales to help get them into a new plan.
What company is considered a Joint Venture with Aetna
Allina Health
What is the difference between warm and cold transfers?
A warm transfer ensures a smooth call transfer between the initial agent and the receiving agent, complete with introductions and context, while a cold transfer is when the initial agent transfers the customer to another agent without warning or any type of introduction involved.
Can you help someone who is not a MB and not authorized on the account
Yes, you can give level 1 information
Strawberry Shortcake calls in furious because she didn't know she was being enrolled into the plan when she was talking to an Agent/Broker over the phone and wants to cancel her enrollment. You see that she receives extra help (LIS) Her plan began: 05/22/24, the date is 07/15/24 of her ph call. How can you help her?
Provide empathy, advise MB options to disenroll, file a grievance for MB misrepresentation or member can use SEP for LIS
What resource can you refer members if they do not have certain benefits on their plan that they want access too
Resources for Living
Jelly Fish calls to say they do not want to have their Aetna insurance anymore. What do you do? Enrollment begins: 03/01/24, the date is 02/27/24
Provide empathy and offer to cancel plan to prevent plan from starting.
What is needed to authorize HIPAA without being fully validated when call comes through?
Name, Mbr ID, & DOB
(if one is missing, you can replace with address)
Laura Loopy is a new member and is not pulling up in GPS with her name, DOB, etc. She doesn't have her member ID. What can you do to try and find her enrollment?
Check Market Prom or Marx using her MBI
Luna Starlight just moved from Alaska to Texas and wants to change her plan. What election period can she use to change her plan? The date is 08/30/2024
SEP for address change OOA this will give her 2 months to find another plan.
What resource can you offer to members that provides discounts of different benefits such as:
Weight Management, Hearing and Vision discounts, Oral health discount program & LifeMart Shopping website?
Value Added Items and Services (VAIS)
Willow Chompers is wanting know if he can add more dental coverage to his plan, where would we be able to see if this is an option?
We would check STARS to see if there is an OSB option and Willow can add it during AEP for the next year or within the first 30 days of his plan starting.