Systems
I am a 3rd party vendor that plays a key role in unresolved major issues like communication (notices/ invoices), payments and enrollment.
What is Softheon?
Prior to submitting this type of Softheon request, you must first: Check validity, look for a credit, and follow the 9-day rule.
What is a refund request?
Use this ticketing system to send issues/tickets to Optum.
What is JIRA?
Members coverage start date needs to move later than current start date.
What is Forward Retro?
What to do and why? The case I am working on is "Awaiting 3rd Party, but is now passed the date listed in the 3rd Party TAT.”
What is: Check the "3rd Party Attention" box to get this escalated to a Team Lead or Supervisor's attention.
I am an on Demand tool embedded into MicroSoft Teams, I use a Knowledge Base Library to locate the answers and save you time sifting through information.
What is MAHC Tier 2 Infobot?
When submitting a Softheon request, you must always protect a members BLANK?
What is Personal Identifiable Information (PII) and Protected Health Information (PHI)?
My acronym is PIM.
What is Production Issue Management?
A member's coverage start date needs to be moved earlier than current start date.
What is retroactive enrollment or retro?
When the member’s coverage or plan information needs to be modified and it cannot be done in one transaction. Member is seeking a retro enrollment date with a plan but needs to have current coverage voided before the retro enrollment date can be processed.
What is Complex Retro Enrollment
I am the enrollment files submitted to the carrier to effectuate members’ coverage.
What is the Electronic Data Interchange?
AKA - EDI files
I am the 3 major issue types commonly escalated via Softheon Service Requests.
What is Communications, payments and enrollments?
You can locate templates and other related documents by using either of these resources when entering a JIRA ticket to Optum.
What is MAHC Tier 2 Infobot or Knowledge Owl?
This type of request is created if the member’s coverage start date of 10/11/2025 needs to be changed to an earlier date of 9/1/2025.
What is Retro Request?
I should always refer to these 4 resources when handing enrollment date changes.
What are:
SOP 147 Enrollment Date Changes
JIRA Ticket Management Job Aid
Retro Enrollment Requirements Changes Job Aid
Outbound Carrier Request Job Aid
Go here to see the EDI Enrollment Files sent. You will see files that show "OUT" meaning the file was sent out by the Health Connector to the carrier, and files that show "In" meaning the carrier sent the file back to the Health Connector confirming enrollment.
What is Softheon Web?
When a Softheon Ticket is marked at this level of severity, it generally takes 3-business days for a resolution.
What is a medium level of severity?
To safeguard member information what step must be taken before attaching a template to JIRA ticket?
What is password protect the template?
Member must have at least 1 month of coverage during the year to submit this type of request.
What is Reinstatement?
To assist a member with Complex Retro Enrollment billing issue I will need to utilize this resource.
What is SOP 140 Payment Research?
I supply you with the details surrounding turn around times expected from 3rd party vendors.
What is Salesforce?
Name the standard operating procedure Tier 2 agents must follow when handling Softheon requests.
SOP 145 Softheon Inbound CRM
The four categories in the MR Playbook related to MA Login issues.
What is:
Deactivate Account and Unlink Account
Duplicate Account
Login Issue - Email Update
Unlock Account - Password Reset
Take these steps to resolve the following issue:
Unpaid Premium Termination Letter - Notice giving Mr. McMahon permission to reinstate without a gap in coverage.
Mr. McMahon's coverage will end due to non-payment of premium on December 31, 2025
What is:
2025 coverage will require a reinstatement.
Reinstate the member into their coverage plan for 2025.
This coverage will end as of 12/31/25 and will not carry over to 2026.
2026 coverage will be a retro enrollment.
The member has no enrollment for 2026 so the agent will need to add an Admin SEP and help the member shop and enroll in coverage.
Then process the retro enrollment to January 1, 2026.
Close your task before closing your case or you will find yourself with this error message.
What is "Hit a Snag!"