Authorizations
What info can you get from the Bene if they do not have their Medicare number?
Their Social Security Number
What are the 5 NTM topics?
How Medicare works, Costs, Signing up, other coverage, How to use Medicare.
Can a Bene switch to a new plan if they were auto enrolled by CMS? If so which enrollment period can they use?
Yes with the autoenrollment SEP
What info should you record in the dashboard?
Info that may be important, Concerns and Questions
What is the date of service? We ask this probing question when we are researching what?
Claims
True or false. When reading a CSR note you should read the note to the Bene.
False
Caller that is not authorized calls about preventative services available to the Bene. Are you able to answer the callers questions?
Yes because they are asking general questions.
Insurance that supplements Original Medicare.
Medigap
What view/applets do you go to in NGD to see an enrollment type?
MA/PDP view, Enrollment history applet
On the BCC Tier 1 screen, disclosure view, where can you see if there is an open escalation?
Beneficiary Indicators
After opening a claim, what info do you read for a claim denial reason under Claim header?
MSN Message
What does it mean if a Bene receives a green letter in the mail?
They received a notice on green paper that lists the prescription drug plan that Medicare will automatically enroll them in if they don’t enroll in a different plan or decline coverage themselves.
What can you do if a Bene needs their Medicare number immediately and has no internet access?
You can provide them with their Medicare number over the phone. You will need to ask the Bene a security question first.
True or False. A Bene can enroll into a MA and a Medigap plan at the same time.
False
What script do you use if Bene does not want to be auto enrolled into a plan again?
Disenrolling and Opting Out
What script do you use to help Bene with issues they were not able to resolve with their plan?
Plan concerns and complaints
What probing questions should you ask when a claim is denied for MSP?
Have you lost employer coverage, Were you injured on the job? Was it due to a car accident?
If it has been less then 30 days since a complaint was filed and it has not been resolved, should you re-escalate the issue?
Do not file a complaint if the caller is calling for the same issue and the plan is still within the 30-day time frame to resolve the issue.
What scripts do you go to if a SHIP counselor calls?
Authorizations, and SHIP Counselor Calling on Beneficiary’s Behalf
How long does the part D LEP last?
For as long as they have MC drug coverage.
What applet under the MA/PDP view shows the auto enrollment Opt Out flag for Part D?
MA/PDP Information
When checking on an escalation in the escalations view, what applet and field shows when a complaint was filed?
External System Status, Date Case received field.
Bene has a MSP and a claim was denied for that reason. What are the Bene’s next steps?
Ask the provider to resubmit the claim
What field should you check on the BCC Tier 1 screen to see when the last time a Medicare card was ordered?
Medicare Card Request Date
Once a SHIP counselor has passed disclosure and you have verified their ID number what info can be shared?
You can share information with them as you would with the beneficiary.
What script do you use to explain Part B services?
Medicare Part B coverage
What shows in the Part D Auto Enroll Opt Out flag field to indicate if they have or have not opted out for auto enrollment?
There will be a Y for yes or it will be blank if they did not.
What fields have information can you read to the Bene when they want a status on their escalation?
Case Status and Resolution Summary
A caller says they are not authorized, but they have an MSN. What are your next steps?
Pass disclosure and let them know you can only answer questions related to the claims on the MSN.
If you have given Bene all info about their escalation but they still have questions what is their next step?
Refer them to the plan for more info