Enrollment/Eligibility
Who is Eligible for Medicare?
What is age 65 and older, under 65 with certain disablilties and ESRD.
Which system is used to process a one-time EFT?
What is PNC
What must you verify to check if a benefit has been used ?
What is Accumulators
Paper claim IDs begin with the letter M. Images of these claims can be found in what system ?
What is ECHS or IOP
How can a member file a standard appeal?
What is in writing or online
What Member Account Changes CANNOT be made unless information is verified in MARx first?
What is Name, DOB, MBI, Gender
After what date of each month is a premium payment considered past due?
What is 10th of the month
What costshares count towards the Member's Maximum out of pocket (MOOP)?
What is Deductible, Coinsurance, Copays
Reworks should be processed in what system ?
What is GPS
In what systems can you view Preauthorization?
What is Medcompass and Evicore/Carecore
(LEP) is assessed __ days after the date at the top of the beneficiary’s initial notice letter. The beneficiary then has an additional __ days from the first initial letter date to complete their attestation.
What is 30,60
What would cause a member to pay a different amount than the standard premium?
What is LEP, LIS, SPAP. OSBs
If a Member is not happy with their medical coverage, What election period will allow the Member to Join, Drop or Switch and when?
What is AEP 10/15-12/7
Using member id 101477823100 and claim number E4FDNJDH0 - what is the member responsibility?
What is $30 Copay?
What Service Request Reason would you choose under the “Add a Service Request” button, to file an oral grievance in GPS?
What is Complaint/Appeal/Authorization
What resource will assist you if you are not familiar with a workflow?
What is Knowledge Articles
Payment options for MAPD members include?
Using Mm ID: 101354653300 , What is the Medicare covered INN and OON coverage for Acupuncture and how many visits were used?
What is
INN: $40 copay
OON: $60 copay
Visits used: 10 out of 20
What is the correct Tab within a Claim to use in HRP in order to identify the Procedure Codes that have been billed?
What is Lines Tab
What system is used to check the status of an appeal or complaint ?
What is medhok
Prospective enrollees have __ days from the date of the letter or the end of the election period, whichever is later, to respond with the necessary information when their enrollment application is incomplete
What is 21 Days
EFT will be Drafted for Members during what time ?
What is 10th of the mth no later than 15th of the mth.
Using ID: 101477823100 , Does this Member have a Deductible ?
What is yes in the amount of $500
What can we verify under claim info to see what benefit was applied to the claim?
What is Benefit adjudication
What are the turn around times for these 3 type of request.
-Standard Pre service Authorization
-Standard post service appeal
-Standard Grievance
What is 14 , 60, 30 days