PES Basics
What does PES stand for?
True or False
We are not able to assist contacts who are calling on behalf of another agent with Application Status.
False - if they are able to verify the agents name, and 2 pieces of HIPAA we will treat them like they are the AOR
What system does UHC use to verify Medicare eligibility?
MARx
Where can the election period booklet be found?
Jarvis home page and the Learning Lab
What is an Agent of Record?
The first agent to complete the accepted and approved application for an active plan.
What system do we use to pull up Member's households (Member account)
GPS
What must be documented in PCL anytime HIPAA is gathered?
All HIPAA verification details and GPS note details
What systems do agents use to submit online applications?
Jarvis Enroll or Third-party platforms (Sunfire, connecture, etc.)
Agents can also submit applications through fax, secure email, and mail.
What is the Election period for when a client is first receiving Part A and B at the same time?
IEP for MAPD/PDP
ICEP for MA Only
What happens if an agent does not include their WID on an application?
They have to use the Jarvis chat to submit an AOR appeal
List two common PES call types?
Application status
missing information
fulfillment
denials
terminations/reinstatements
Does the Principal of an agency have to verify their full name and their Agency's name?
No
Where would an application be in GPS if it is pending for Medicare information such as the MBI?
The GPS Work Queue
What is the election period for when a client did not receive their Part B at the same time as their Part A, but are receiving it now?
ICEP - Part B and the plan must have the same effective date for it to be valid
What determines whether a lapse in coverage results in a new AOR?
If a member spends a month or more not covered under the prior plan
Who typically contacts PES for assistance?
Agents, agent contacts, members, enrollees, or authorized representatives
If the member is NOT found in Jarvis application status, what follow-up information is required?
The members Date of birth, and one of the following
-Medicare number
-Member ID
- Full address
What system is used to view paper applications or missing information received (such as Medicaid award letter, Chronic forms, etc)
View
What is the Election Period for when a client just received Medicaid?
SEP - Change in Dual/LIS status
Does AOR retention apply to PDP or Med Supp plans?
No
What date timeframe defines CCM and CCM -1 ?
CCM = Current Calendar Month effective date
CCM -1 = Current Calendar Month minus 1 (previous month effective date)
Can you give member or application information to an agent who is not AOR?
No unless the member is on the phone and provides verbal permission
What is the system we use to verify SCO clients?
Facets
What are the Qualifications to use the Integrated SEP and are they similar to Dual Maintaining?
Allows enrollment once per month into a Fully Integrated Dual Eligible SNP (FIDE), Highly Integrated Dual Eligible SNP (HIDE), or Applicable Integrate Plan (AIP) for full benefit dually eligible individuals who are enrolled in, or are in the process of enrolling in, the D-SNP’s affiliated Medicaid Managed Care Organization (MCO) to align enrollment
No it is quite different
If a member completes an application with UHC internal Telesales does the original agent retain AOR?
Yes.