Medicaid
Can I order a Medicaid card for the member?
NO, we can only send UHC Medicare plan ID cards. Give them their state Medicaid office number and let them know they have to order a card from them.
What is OTC? What are 3 things member can buy with their Solutran OTC/HF benefit?
OTC - Over the Counter benefit
Ex; Healthy food, tylenol, shower seats
Which intent do you use to change PCP?
Search and Assign provider
Member says they got a letter that they need to sign and return. The letter mentions Benelynk.
What is this letter and what do you tell the member?
This letter is legit, reassure the member that
UHC has contracted with two external vendors (BeneLynk and Change Healthcare) to outreach to Medicare and DSNP members based upon identified social and/or financials needs of the members, which are also referred to as social determinants of health (SDOH).
BeneLynk and Change Healthcare divide their assistance to UHC Medicare members by the populations they serve.
These vendors help members apply for a wide variety of assistance program that can help to improve the financial and/or social challenges identified for the members. This assistance includes:
Member needs an INN dentist, what site do you use?
Member has level 03-SLMB Medicaid is their cost share covered?
No- partial members Medicaid does NOT pay cost-share or copays
Explain the difference between Home Health and Custodial Care
UHC only covers skilled Home health that includes a skilled service (OT, PT, Wound care, etc.
Custodial care= bathing, cleaning, cooking, companionship with no skilled service. UHC plan does not cover that but full Medicaid levels can.
Which intent do you use if the member has a grievance?
Complaints Appeals and grievances intent AKA CAG
Member got a letter stating their doctor is no longer INN. What do you do?
You offer to find the member a new provider using search and assign provider intent.
Call is transferred in from another department, they state that the member needs to update their address. When they come on the line it's not the member but the AR. What do you do?
We must get the members permission to update address even with an AR on the line.
How can we verify members Medicaid status?
DMEVS or MARx
What are the names of our transportation vendors? Which one do we do ourselves?
Modivcare, Saferide, and Comfort Care
Saferide
What intent do you use find out what members vision benefits are?
Review medical benefits intent
What is an EOB?
THIS IS NOT A BILL. An EOB is an explanation of how UHC Medicare plan paid the members claim. You should reassure the member that it isn't a bill and the member responsibility or cost-share shown is picked up for the member by Medicaid if the member has 01-QMB, 02-QMB+, 04-SLMB+ or 08-FBDE levels of Medicaid.
The member is moving to a new address in a different county. What are the steps you need to take to change their address?
Use the update member address intent. Enter in the new address and the system will verify the address, if there is a region change the member MUST change plans so you need to warm transfer to telesales.
What levels of Medicaid cover cost-share?
Level 01- QMB, 02-QMB+, 04-SLMB+ and 08-FBDE
Can you assign a dentist or specialist to a members account?
NO. You can only assign a PCP to a members account
What intent do you use to send member a new UHC ID card?
Member materials intent
Member got a letter stating that their plan with UHC was going to end/terminate and they were going to be released from their plan. What is this and what do you tell the member?
Plan change letter- This is a standard letter that is sent anytime that a member changes plans. Verify members current plan is active and see if there is an upcoming plan change
PAR technique (Plan/application/Recent interactions)- Plan tab first to check plan status. then go to application to see if they will be with us-you can also check MARx. Then check recent interactions to see if they lost Medicaid status or any other info
Member tells you that they need hearing aids, what do you do?
You would first look up the members hearing benefits and see who hearing vendor is. Then warm transfer to hearing vendor.
What is the difference between Medicaid and LIS?
Medicaid is a separate insurance provided through the state and can act as a secondary and pick up members cost-share if (QMB, QMB+, SLMB+ or FBDE). LIS is extra help for part D deducible and Rx Copays- it is a federal program that is separate from Medicaid but if a member has Medicaid they automatically qualify for LIS.
Explain the DME process
Members doctor must sent an "order/prescription" to a DME provider who then will send a prior authorization (if needed) to UHC approve and pay for. DME provider will order and deliver the item to the member.
Where can you find members Medicare ID number?
Member tab, "Medicare Claim Number"
Member got a letter stating that UHC is going to start taking premium payments out of their social security. What do you tell the member?
This is a method of payment letter, all it stating is that when the member applied for the plan, they selected social security deduction as their method of payment choice. Because our plans have a $0 premium they will not have anything deducted from their social security. Reassure the member that they will not have anything deducted from their social security from UHC.
Member tells you that they were recently in the hospital and they are interested in Moms Meals. What is the process?
Check benefit. Check ICUE for approved inpatient hospitalization within the last 30 days. Warm transfer to UCS team if member qualifies. DO NOT call Moms Meals for Post discharge meal benefit.