Claims
This number is the most common way to search for a member in Xerox.
What is the member ID#?
If the applicant receives Social Security Income, we request one of these 3 documents to verify this income
What is the a copy of the SSA-1099 form, current Social Security Cost of Living Adjustment letter (COLA), or Social Security benefit letter.
On question #3 of the phone application, an MSR always selects this as the answer.
What is "you only"?
After completing an LIS application, an MSR would complete this letter in BEES
What is the LIS Manual letter?
With this service, you will receive a comprehensive review of your medications and prescription drug coverage.
We provide information that includes assistance with accessing affordable prescription drug programs through the Medicare Drug benefit, as well as medication assistance options for other uninsured or underinsured residents of Massachusetts.
What is MCPHS?
We would send this if we seeing missing claims in Xerox that are over 14 days old.
What is a paper claim form?
These are the six categories PA will consider Removable Income
What is Wages, 3rd Party Sick Pay, IRA, Pension/Annuity, Unemployment, Alimony?
When completing an application, this identifying number is optional
What is the SSN?
Getting “Extra Help” means that Medicare helps pay these 3 parts of your Medicare Prescription Drug Plan
Monthly Premium
Deductible
Copayments
Shauna Post, is the Regional SHINE Director in this region
Where is Berkshire county?
This is the tab in Xerox where I can see how much a member has accumulated towards their Out of Pocket amount.
What is Benefit Limits?
What is the previous year's 1099-R?
You have a married applicant. If the applicant answers "NO" to the working question on the application, but says "YES' to having wages on the tax return, the MSR should clarify this
What is to whom do the wages belong to (i.e. spouse) and when did they/spouse stop working?
This # is important if they want to continue the application at a later time.
What is the Re Entry #?
These 2 things are needed to create an account for an online application
What is a email address & Password?
This is a statement a member receives from their Part D plan the explains how the plan paid on their claims.
What is an EOB (explanation of benefits)?
Applicant indicated that he is not currently working, but answered YES to having wages on his tax return. He stopped working earlier this year.
We would ask the applicant to submit these 2 things to consider removing this income.
Letter from former employer on company letterhead indicating the last date of employment and the previous year's W-2
If the applicant does not want to consent to the Terms of Agreement on the PA application, this happens next.
What is, the application cannot be submitted. Let the applicant know that you will send him/her a paper application to complete.
This is completed and used when an MSR assists with an LIS application outside of the phone application process.
What is the LIS Action Form?
This is when someone has an ID Number created in BEES but it is either in a Denied or Terminated status. They now want to re-apply by submitting a new application.
What is a Reactivation?
When escalating a claim issue to Tier 3, these are the 8 pieces of information you should include in your CM note.
What is:
1. Pharmacy Name & Telephone Number:
2. Date of Fill (DOF):
3. Drug Name:
4. Strength/Dosage:
5. Day Supply (DS):
6. Quantity (Qty):
7. Amount Charged: $
8. Day Supply Remaining:
Letter from the Nursing Home Facility to verify date of Residency
You select this option under the "Exception to Open Enrollment" section of the PA application
What is "Not Provided"?
In the section of the LIS Application named " About the Person completing this form", this is the first and last name used in this area of the application.
What is
RxAdvantage - (First Name)
Customer Service - (Last Name)
For a married applicant, these are the income limits AND resource limits to qualify for LIS.
What is income below $24,690 and assets below $28,150?