Medicare and GPS
Member documents can be found
What is under policy name, health documents?
The P in PEAS stands for
What is P for paraphrase?
True or false: when documenting a call, is it okay to not document everything?
What is false?
This system is used to make payments
What is PNC?
True or False: Can we file a grievance against a doctors office staff being rude?
What is true?
Benefits SR’s are created in
Where is benefits tab, clicking on SR box for benefit discussed?
True or false: The A in PEAS stands for action?
What is false
When documenting a call we want to include the 5 ____
What is W’s?
Where can we find documents that have been mailed or faxed to Aetna
Where is ECHS?
How do we start the grievance process?
What is under create service request, drop down to complaint, appeal and authorization?
The 3 things needed to close a case
What is case comments, subject and service request?
When a member is having an issue we should show ______
What is empathy?
True or false: should we include curse words when documenting a call?
What is false?
DAILY DOUBLE!!!!!!!
There are two systems to check a members Medicaid level
What is MedCompass and Marx?
how long does a member have to file a grievance?
What is 60 days?
TRIPLE POINTS!!!!
Name the 4 types of Medicare plans and which plan pays for hospital cost?
What is Parts A, Parts B, Parts C and Parts D?
What is Part A pays for hospital costs?
Recapping what the member called in for is called __________
What is summarizing?
If we quote it we should _____
What is note it?
Grievances and appeals can be found where
Where is MHK?
Can we file a grievance for an LEP?
What is no?
A member has _____ days to get creditable coverage before getting a _______?
What is 63 days and what is LEP (late enrollment penalty)?
After the member states what they need help with we should ______
What is paraphrase?
Case comments should be considered a _____
What is legal document?
We can find forms to send to the member in what system
Where is OneKit
When a member calls upset with an issue that affects their Medicare, we should ask permission to file the grievance true or false
False, we don’t ask permission we let the member know we are filing a grievance.