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Servicing
Medicare
MA
Medical Services
Special Groups
100
Who are two types of customers BCBSM MA services?
What is members and providers
100
What organization oversees Medicare?
What is Centers For Medicare and Medicaid (CMS)
100
What part of Medicare is Medicare Advantage considered?
What is Part C
100
The majority of our MA membership is in what plan?
What is Medicare Plus Blue PPO
100
What are the two largest MA groups?
What is UAW Trust (URMBT) and Michigan Public School Retirement System (MPSERS)
200
What are the three BCBSM "persona's"
Who is Mike, Lisa and Grace
200
True or False: To be eligible for Medicare a person MUST be 65 or older?
False. To be eligible for Medicare coverage, a person must: - Be a United States citizen. - Be a permanent resident of the U.S. - Be 65 years of age or older. - Have a qualifying disability if under 65 years of age. - Have End Stage Renal Disease (ESRD).
200
What type of plan is Medicare Plus Blue considered: An HMO or PPO?
What is a PPO.
200
What are the four plan options available to a Medicare Plus Blue PPO individual member?
What is Essential, Vitality, Signature and Assure
200
True or False: Auto Club, City of Rochester and Michigan Catholic Conference Lay Retirees are all GlidePath groups.
False: Auto Club, City of Pontiac and Michigan Catholic Conference Lay Retirees are all Glide Path groups. Note: All GlidePath groups offer more than one option to their retirees.
300
Resolving the concern or issue on the caller's first contact with BCBSM is considered what?
What is First Call Resolution.
300
Name three services that Medicare Covers
What is inpatient and outpatient hospital services, Physician Care, Skilled Nursing Facility Care, Home Health Care, Hospice Care or Durable Medical Equipment
300
What does PFFS stand for?
What is Private Fee For Service.
300
What is an enhanced benefit?
What is enhanced/additional benefits provide additional coverage beyond what is covered under Original Medicare.
300
What are the two states that are Passive for UAW Trust members?
What is Missouri and Tennessee
400
What is the name of the free Medicare Advantage fitness program that provides memberships at participating gym locations?
What is Silver Sneakers.
400
Where is Part D (Prescription Drug) Plans offered through?
What is Private Insurers. For example, Medicare Advantage or Standalone Part D Plans.
400
How many STARS does BCBSM Medicare Advantage have?
What is four STARS.
400
True or false: Chiropractic X-Rays are covered by Original Medicare, so Medicare Advantage has to cover them.
Flase: Original Medicare only covers the manipulation of the spine to correct sublexation. Spinal X Rays in Chiropractors office, initial exam, physical therapy in a chiropractors office are all considered enhanced benefits and have to be listed in the EOC to be covered.
400
What group receives the same benefits as individual members but has a difference group number for reporting purposes?
What is AT&T
500
What is the source of truth for provider networks?
What is Portico
500
What is the difference between Medicare Part A and B?
Medicare Part A is usually covered by the federal government and covers hospital and institutional expenses (Original part of the Blue Cross business). Medicare Part B offers coverage for physician services, outpatient services, ambulance services and preventative services. This includes a premium, deductible and 20% coinsurance for approved services. If those eligible for Part B are not enrolled in Part B they could be subject to a penalty. (Blue Shield part of the business)
500
Name all of the plan types BCBSM offers through Medicare Advantage.
What is a. Prescription Blue PDP b. Medicare Plus Blue PPO c. Medicare Plus Blue PPO Core d. Medicare Plus Blue PFFS
500
What is the disclaimer CSR's must give on calls regarding Durable Medical Equipment (DME) benefits and eligibility?
What is to obtain Durable Medical Equipment there needs to be prescription or Certificate of Medical Necessity provided.
500
What is the Deductible and Out of Pocket Maximum for 2017 MPSERS MA Members?
What is $800 deductible and $1700 out of pocket maximum.