AEP 2027
What is AEP?
Member that qualify for the D-SNP and Medicaid qualify for?
Extra Help (LIS)
A&G
Appeals and Grievances
What is a claim?
Is like a bill that are sent to medicare and medicaid
Who qualify for DSNP?
Each year in September, members receive a document called the...?
Annual Notice of Changes (ANOC)
Where do we find the Formulary Look up?
Review Rx benefits
Annual Notice of Change
Member with partial medicaid has to pay their claims? Why?
Yes, because as they are partial medicaid, medicaid is not responsible for members deductibles, copays and coinsurance
Types of DSNP plan?
HMO and PPO
AEP Dates?
October 15- December 7
Prescriptions classes
Therapy, Controlled Substances, Specialty Drug
CD
Coverage Determination
Parts of medical claims?
Provider Detail, Service Line Detail, Claim Detail, Financial Detail
Is an HMO plan, it means members can only go to providers in network
What brand is the UCard?
Mastercard
The medications that are covered under part... are administered to you by someone in a professional setting.
Part B
HRA
Health Risk Assessment
It will tell us if it was denied and why
Claim Detail
UHC benefits?
Housecall visit, OTC, utilities payments, healthy food, rewards activities
Is the UCard a pinless debit card?
True
Part D prescription drug payment requests address?
Optum Rx
P.O. Box 650287
Dallas, TX 75265-0287
NOD
Notification of Death
Claims address
UnitedHealthcare
P.O. Box 30995
Salt Lake City, UT 84130-0995
What happens when a member does not recertify their medicaid?
They will loss their medicaid eligibility and will enter a grace period of 6 months where they will have to recertify their medicaid, meanwhile that happens they will be treated as a partial medicaid.