Parts of Medicare
Hospital Insurance helps cover:
What is Medicare Part A?
Change your Medicare health or prescription drug coverage from October 15- December 7
What is Annual Election Period (AEP)?
Upon release from the hospital, the attending provider or the customer's care coordinator will order from the vendor, GA Foods.
What is the Post-Hospital Meal Benefit?
An enterprise application system that encompasses functional areas like claims, customer service, provider services, medical management, finance, and accounts receivable for businesses managing single or multiple healthcare products.
What is QNXT?
Customer wants to know his/her MOOP
What is Benefits-Explained MOOP?
Medical Insurance helps cover:
What is Medicare Part B?
This period allows customers to review their changes. If the customer chooses to no longer stay with the plan they selected, the customer may disenroll back to traditional Medicare with or without a Part D plan or purchase a non-guaranteed issue Medicare supplement plan. Customers enrolled in a Medicare Advantage plan may enroll in a different Medicare Advantage plan. From January 1st- March 31.
What is Open Enrollment Period (OEP)?
A feature added to a Medicare Advantage HMO plan. It allows the customer to see a provider (health care professional) outside of the plan's network of doctors.
What is a Point of Service Benefit?
An instant messenger application that allows you to message anyone in the world in real time.
What is Skype or LYNC?
Customer wants to know if his/her plan has the transportation benefit?
What is Benefits- Explained Transportation?
Medicare Advantage:
What is Medicare Part C?
Beginning the month that a customer becomes eligible for Medicare, they will be allowed to enroll in another Medicare Advantage Plan or disenroll from their Medicare Advantage plan and return to original Medicare.
They may make only ONE election during the Medicare Advantage Open Enrollment Period extension, and will have until the last day of the 3rd month of their entitlement.
What is Initial Coverage Exception Period (IECEP Extension)?
Enables customers to conveniently visit a behavioral health provider via audio or video
What is Telehealth Behavioral Health Benefit?
Provides the framework necessary for claims to adjudicate properly and quickly against a defined benefit plan, providing a quick turnaround of information not only to the pharmacy, but to the benefit manager as well.
What is Optum RxClaim?
Reissue ID Card because PCP change
What is MAS- Requested ID Card PCP Change?
Medicare prescription drug coverage:
What is Medicare Part D?
A customer moving out of the current plans service area
What is Special Election Periods (SEP)?
Customers have access to fitness facilities and instructor-led classes, exercise centers, or home fitness kits (two per year) so they can exercise in the comfort of their own home.
What is the Fitness Benefit?
A web-based phone system Cigna-HealthSpring uses.
What is Finesse?
Cancel a customer's Electronic Funds Transfer
What is PREMBILL-Explained Disenrollment for Nonpayment?
Includes Part A (Hospital Insurance) and/or Part B (Medical Insurance)
1. Medicare provides this coverage directly.
2. You have your choice of doctors, hospitals, and other providers that accept Medicare.
3. Generally, you or your supplemental coverage pay deductibles and coinsurance.
4. You usually pay a monthly premium for Part B.
What is Original Medicare?
New Medicare beneficiaries who have "aged-in". New beneficiaries can sign up when they are first eligible for Part A and/or Part B.
What is Initial Enrollment Period (IEP)?
Congestive Heart Failure Heart Health Program
What is Telemonitoring Benefit?
Manage clinical case management decisions, with add-ons for appeal processing and documentation for Medicare Part C.
What is CCMS?
Customer chooses to complete premium payment over the phone with IQOR
What is PREMBILL-Explained Premium Invoice/Payment?