Week One
This is your primary resource to use when you have a question.
Knowledge Central
Where to find a document that was sent to a member.
Doc360
A CAG for Part C is called
Organization Determination
True or False
Reward balances expire after 12 months.
FALSE
Reward balances do not expire even if a member leaves their plan.
DMR stands for
Direct Member Reimbursement
This is the Election Period we are currently in.
Annual Enrollment Period
The intent in Maestro used to reprint a Members EOB.
Member Materials
Transportation, Solutran, and Fitbit are 3 examples of what?
Wellness Benefits
The Maestro intent used to enroll a member into paperless billing.
Update Member Profile
Our records indicate you may have had a gap in prescription coverage. This resulted in a
Late Enrollment Penalty
3 things you need to hipaa verify a member.
First and Last Name
Date of Birth
Member ID OR Full Address
The tool to use if you are unsure about which intent in Maestro to choose.
Call Assistance Tool
What website can you use to Find a Gym for a member?
Medicare Fitness Program | UHC Renew Active
What is the Donut Hole and how can you tell a member is in it?
The Coverage Gap. The period between the member meeting the Initial Coverage Limit and prior to meeting True Out of Pocket (TrOOP) cost. In this level of coverage, the member is responsible for a percentage of their drug costs. ex. 25%
Determining Primary Payer helps us to determine
Coverage of Benefits
The intent you need in Maestro to update a members PCP.
Search and Assign Provider
What to use when a member is asking about their medical and prescription benefits and you are unsure what to search for in Maestro.
Quoting Benefits DT
True or False?
All virtual visits for Medicare have a $0 copay.
TRUE
The Shingrix vaccine is covered under...
Medicare Part D
A member is convinced they have UHC Medicare but you can't find their account. What do you do?
Look them up in MARx
Name 3 Preventative Services that are A4Me - Next Best Actions
KM1229827
Annual Physical and Wellness Visit , Blood Sugar, Breast Cancer Screening, Colon Cancer Screening, COVID-19 Vaccine Eligible Members, Diabetic Eye Exam, Group Retiree Diabetes Support Program Diabetic Kidney Disease, Flu Vaccine Reminder, Housecalls, Hypertension Support Program - Group Retiree, Kidney Resource Services, Osteoporosis, Rheumatoid Arthritis , Risk of Fall
MYSTERY
Share your screen.
Show one way of finding a members benefits.
911648526 if needed.
A member is upset with their interaction with the last advocate saying they were very rude. What do you do?
Submit a Verbal Grievance
Show us how - 911648526
Give the KC/KM number where you find the State Assistance phone number for Puerto Rico.
KM1225807
Puerto Rico
State Medicaid Program
0-6 for Detractor
7-8 for Passive
9-10 for Promoter
are what?
Part of the NPS rating system