Abbreviations
CMS
What is Centers for Medicare and Medicaid Services
I can look at this tab to see when a member has called in before
What is the Previous Tickets Tab
Call Driver Definitions
What is Medicare CareConnects Call Driver Guide
T or F: If its Red it Must Be Said!
What is False. If its red, its NOT said
All calls must be documented
True. While CareConnects does document most things for us, there are additional notes sections in case we need to add further details for the call driver we are in. All calls get documented, one way or another!
SEP
What is Special Election/Enrollment Period
I can order an ID card from here
What is the Material Request Call Driver
Daily Double!!!
I can use these two articles when I want to verify a third party caller Prior to releasing information
What is the POA/AOR/AR HIPAA reference guide or Understanding PHI and HIPAA and Third Party Callers
Two part question
True or False: Medicare has three parts. - 100 pts
Which article do you find that in?
What is False.
Medicare has 4 parts. ABC and D.
Answer: Medicare and Medicaid Basics
If a member calls up on the 15th of November for a PCP change, it will automatically be on the account the 1st of November.
What is False. The last day the caller can have the PCP automatically reverted to the 1st of the same month is between the 1st and the 10th. From 11th on, it reverts to the First of the Next month ( in this case the 1st of December)
OEP
What is Open Enrollment Period
I can do a Cardiologist Look-up from here
what is Update PCP > Provider lookup
Talking Points on Health Reminders
What is Addressing Health Reminders with Members in CareConnects
Daily Double!!
Demonstration: Choose one from your team, and, sharing your screen, demonstrate how to back out of an incorrect call driver.
What is:
Cancel call, Are you sure: Yes, Wrong Call Driver Selected
If a material request goes out, the TAT is 14 days
True.
Confirmation: CareConnects or Material request Tab Functionality in Centralpoint
AOR
What is Appointment of Representative
Without an OOSA letter, I can do an Address Update from here
What is the Address Change Tab (not call driver)
A Member calls in requesting more information about Annual Enrollment Periods
What is Enrollment Periods
T or F: If its black, repeat it back
What is False: If its black, Don't repeat back
Agents must confirm 4 items with member:
Member Name
DOB
Address
Phone Number
to verify the call.
What is False.
Member confirms: Member Name, Member ID, DOB
Agent Confirms: Address, Phone Number
That makes 5 things in all.
SPAP
What is the State Pharmaceutical Assistance Program
If a member has another concern, there is an Additional Notes section in each call driver for that : True or False
What is False. If the member has an additional Concern we would finish the call driver we are in and address their concern with either another tab or another call driver.
What system do we use to order OTC brochures?
What is CareConnects
This is how long it takes to process a grievance with the health plan
What is 30 days
Members have 4 different types of disenrollment
What is True.
Erroneous, Involuntary, Voluntary, and MA OEP accidental disenrollment