KNOWLEDGE
what's three pieces of verification is needed for HIPAA?
first and last name date of birthday and member id
How many days does it take to receive member id card?
7-10 business days
Who are the two transportation vendors?
Modivcare and Comfort Care = PMG
WHICH INTENT IS USED TO REQUEST MEMBER ID?
MEMBER MATERIAL
WHICH INTENT IS USED TO REVIEW MEMBERS BENEFITS?
REVIEW MEDICAL BENEFITS
WHAT PLANS DO WE NOT OPEN MEMBER ID STARTS WITH WHAT NUMBER
1 AND COMMUNITY AND STATE PLANS.
WHAT INTENT DO YOU USE TO CHECK PHARMACY CLAIMS?
under pharmacy and claim history
What intent is used to check medical claims?
claims and review medical claim history history
How MANY DAYS MUST TRANSPORTATION BE BOOKED IN ADVANCE?
at least three
WHCIH INTENT DO YOU USE TO CHANGE PCP DOCTOR?
SEARCH AND ASSIGN PROVIDER
what does DME stand for and which part of Medicare is it classified under?
DURABLE MEDICAL EQUIPMENT AND PART B
WHAT ARE THE DIFFERENT LEVELS OF MEDICAID?
00,01,02,03,04,05,06,08
WHAT MUST PROVIDER SUBMIT FOR DME EQUIPMENT AND WHO DO THEY SUBMIT IT TO?
PRIOR AUTHORIZATION AND TO DME SUPPLIER
IF MEMBER CALLS TO REPORT A COMPELTED HELATH ACTIVITY WHO DO YOU CONTACT?
RENEW REWARDS
IF MEMBER WANTS TO CHANGES PLANS WHO DO YOU TRANSFER TO AND WHAT KIND OF TRANSFER?
TELESALES WARM TRANSFER
WHAT IS THE DIFFERENCE BETWEEN COMMITTMENT IN COMPASSION EMBRACE AND WHO COMPLETES THEM AND WHEN DO YOU NOT SET EITHER?
COMMITTMENT IS 24 HOURS AND CANNOT BE SCHEULDED ON FRIDAYS OR WEEKENDS.
COMPASSION EMBRACE IS OVER THEN 24 HOURS
WHEN MEMBER HAS A NAVIGATOR
WHAT IS THE DIFFERENCE IN STANDARD AND RETRPO CHANGE WHEN CHANGING PCP?
STANDARD CHANGE TAKES EFFECT THE FIRST OF THE FOLLOWING MONTH
RETRO CHANGE IS BACK DATED TO THE FIRST OF THE MONTH YOU ARE CURRENTLY IN AND REQUIRES A OVERRIDE.
WHAT IS GYM MEMBERSHIP CALLED AND WHAT DOES MEMBER NEED TO JOIN?
RENEW ACTIVE AND RENEW ACTIVE CODE
WHAT SYSTEM CAN WE USED TO CHECK MEDACID?
DMEVS
WHAT SYSTEM CAN WE USE TO CHECK THAT MEMBER INFORMATION MATCHES MAESTRO?
MARX
How often are otc/healthy food benefits card loaded and when and do they roll over?
monthly and at the first of every month and they do not rollover.
what are NBAS and what are the for and is it mandatory you discuss them ?
next best actions identify and deliver on life-saving opportunities, connecting members with screenings and other preventative services. Yes
when should you submit a complaint or verbal grievance on members behalf?
any time member expresses dissatisfaction about a matter.
what are the systems we use to assist members and take calls?
Avaya, Genesys, Maestro Knowledge Central
what does PART D Medicare coverage cover ?
prescription drugs or rx