Payments
An advocate can add a new credit/debit card by doing what
Connecting the member to SecurePay
Which reason would make the member ineligible to opt in?
Member's who don't have an active Part D plan or a LiNet plan
What happens if participants do not pay their MPPP billing account balance after the grace period ended?
They are involuntarily opted out of the program
The ____________________________ was designed for members with high-cost drugs that opt in early in the year to spread out their expenses over the course of the year
Medicare Prescription Payment Plan
Regarding back-dated effective dates, participants have no more than _____ hours from the adjudication of the claim to make the request.
72
____________ pays the pharmacy the cost share amount participants would have normally paid, and then bills the member monthly for any costs they incurred while in the program.
Humana
How often are participants able to opt in or opt out of the MPPP?
Anytime
In this scenario, the participant is at the pharmacy and is not able to pick up their prescription because they cannot afford to pay out-of-pocket for the medication, and the participant’s health may be at risk if they do not have their medication. This situation requires _______________________.
Access to Care
____________________ costs for Medicare Part D includes copayments, coinsurance, deductibles paid directly by beneficiaries when purchasing prescription drugs covered by their plans, after insurance or subsidies.
Out-of-pocket
How long can it take to process a refund before a check is sent out?
Up to 14 calendar days
A participant’s first bill on the program will be different than later bills and is based on their _____________________.
Maximum possible payment
Participants who change to an ineligible Part D plan are involuntarily removed from the program. The participant must request to ______ their new Part D plan.
Opt in.
How long is the MPPP billing grace period?
60 Days
Drug costs are spread out ________________________ in the form of a monthly payment rather than all at once at the pharmacy
Over the course of the plan year
MPPP balances will keep accumulating as more prescriptions are filled until participants reach their Part D plan’s _______________________ limit.
True out-of-pocket
Participants will pay _______ at the point of sale (for both retail and mail order pharmacies), for a covered Part D drug, instead of what they would normally pay the pharmacy when filling a prescription.
0.00
Per the Retro Opt In Mentor document, Advocates must follow _____________________________ before completing the Retro Opt In procedures.
Designated Advocates MPPP Eligibility Determination
What is the turn-around time Humana asks participants to allow for posting mailed or check payments to their MPPP account?
7-14 business days
A Member with one high- cost drug and all other drugs are low cost wants to opt in to the payment plan early in the year. How would you determine if the payment plan is a good fit them?
Explain the program and provide other savings program options. Determine if the member received a letter from a drug manufacturer or from a likely to benefit letter from Humana. Review the good fit screening when one of those letters hasn’t been received and ask 3 out of the 5 questions. Offer the opt in options and assist with next steps upon member’s request.
How many screening questions need to be asked to determine if the program is a good fit for the member?
3
From the MyHumana dashboard, participants can access the MPPP portal by clicking the _____________________ link on the tile.
Manage payment
Which pages in the MPPP portal will have the member’s balance?
Payments & Claims Tab
The MPPP Notice of Denial (Preclusion) letter ME4250 is sent when a member________?
Is denied participation in the MPPP program because of nonpayment of a previous balance
Within the Medicare Prescription Payment Plan section of the RxNova Claims Detail screen, we can determine (A) Active or (I) Inactive program status by checking the ______________________ field.
MPPP Association Ind
Which refund option is selected in the MPPP Portal if the participant paid more than they were invoiced?
Member Refund