Show:
MIIM
Acronyms
Medicare
HIPAA
A&G
100
MIIM
What is member interaction and issue management?
100
RSS
What is Resolution Support Specialists?
100
Age 65 and up, has ESRD, people with disability
What is requirement for Medicare?
100
Member's first and last name Member's date of birth One of the following: Member ID OR… Medicare ID OR… Complete permanent address
What information do you need to authenticate your call?
100
A&G
What is Appeals and Grievances?
200
Application, General, Billing, Claim, Enrollment, Member, Pharmacy, and Plan.
What are the categories inside of MIIM?
200
RRS
What is Research Resolution Specialists?
200
Medigap
What is another name for Medicare Supplement Insurance?
200
It was created in 1996, and addresses a number of issues, including the protection of confidential enrollee information.
What is Health Insurance Portability and Accountability Act?
200
When a member expresses dissatisfaction with any aspect of the plan.
What is a Grievance?
300
Member ID, member name, member DOB, member Medicare id.
What information can you use to search for a member account?
300
CTM
What is Complaint To Medicare?
300
Parts A&B
What is original Medicare?
300
General information not specific to the member.
What is basic plan information?
300
A request for the plan to make a decision.
What is a determination?
400
Static header and member 360 view
What are two locations where you can find the members demographics?
400
CMS
What is Center for Medicare and Medicaid Services?
400
Deductible, initial coverage, coverage gap, and catastrophic coverage.
What are the four coverage levels?
400
General information about the member's premium coverage or specific plan information directly linked to the member. I.E Payment options and LIS status
What is member enrollment information?
400
If the determination is not what the member has requested and he/she is unhappy about it, and he/she ask the plan to reconsider.
What is an Appeal?
500
This symbol (%) finds all matches containing a specified string of characters.
What is the wildcard search?
500
PFFS
What is Private Fee For Service?
500
Covers hospital stays, doctors visit, medications, and may include dental, hearing, and vision benefits.
What is a Medicare Advantage Prescription Drug Plan?
500
Who is the caller, member full name, verbal authorization, member id, member dob, reason for the call, and resolution
What information should be document on every call?
500
When the member calls Medicare directly to complain
What is a complaint to Medicare?