Appeal and Pre-Hearing
If an applicant contacts the Cover Virginia Call Center (CVCC) and expresses dissatisfaction with their application determination, and the application was processed by Cover Virginia, the CSR
Apologize and sympathize and the offer a conference with the eligibility worker who will further explain the determination using the Pre-Hearing Conference script
What does FFS stand for?
Fee For Service
In what system can we find the task flow?
Panviva
____ Is like an insurance policy deductible.
Spend Down
If it meets the aid code criteria as a "Deemed Newborn", what is the name of the form the CSR will complete?
Call center deemed newborn form
if the caller doesn't want a pre hearing conference what do you offer them?
Ask if they would like to file out a new application.
What does TPL stand for?
Third Party Liability
In what systems would you find NOA's in?
Applications for _____ & ______ that are denied for excess income will require an additional ___________ to be completed .
1: Children
2: Pregnant women
3: Form, Appendix E
What to say when a caller claiming to be an AR cannot be authenticated. If the caller is calling on behalf of someone else and they are not authorized:
“Unfortunately, I do not see you listed on the case as an authorized representative. Is the person you're calling about currently with you?"
What are 3 reason for a pre hearing?
Untimely processing, case closure, denial
What does ATC stand for?
Access To Care
True or Fales
We can remove a TPL in MMIS
Fales
How long can the spend down coverage period last?
1-6 months
Why would you receive a call with questions about MAGI Household Composition?
When an applicant is filling out a paper application or an application online, they may need assistance in determining who should or should not be included.
What application will you file a pre hearing?
Connection Point
What does DOS stand for
Date Of Service
When heading billing & claims calls where do you check to see if a client has active coverage?
MMIS
Who can qualify for a spend down? Name at least 2.
-ABD Clients
-Pregnant women and their deemed newborns
-Children under 18
-Foster care and adoption individuals under age 21
What will happen when a CSR tries to open a new change, after a previously reported change has not been submitted?
An error message will appear
How do we check the status of an appeal that is NOT with Cover Virginia? and what should you do after?
- There is no way for us to know the stage of the appeal or know if it has been received.
- Provide the client with the Appeals Division phone number and then after providing the number, offer to transfer.
What does APTC stand for?
Advance Premium Tax Credit
Where do you report change?
BONUS: Show us how would you do it (double points) *get it wrong lose double points
VaCMS
Name at least 3 medical expense deductions include what? Name at least 3.
-Dentist bills
-Hospital bills
-Prescription medicines
-Health insurance premiums
-Certain medical supplies
What are 3 type of escalation?
*Emergency
*Pregnant Women emergency
*Non emergency