Eligibility
In order to enroll into a Prescription Drug Plan, what are the requirements?
-Client lives in the Service Area (state)
-Must have a valid Election Period to Enroll
-Active A and/or B
What system can we use to verify client HIPAA once we are given First and Last name?
Jarvis - Application status/Book of Business
Updating the Medicare number on a pending application
In our Scope
We will verify the MBI the agent gives us in MARx and update under the maintain if in household/work queue app
01/14/2025: per SR-123456789 AOR Bobby Brown WID 54321 CI to cancel the PDP plan they put in. prior to ED. tagee2
What is Missing?
The Plan name and Effective date
When a Chronic application is pending for the Chronic Verification form, what form does the agent need to send in?
Pre-Assessment Questionnaire located in the Enrollment Guide in SMP
In order to enroll into a Medicare Advantage (Non SNP), what are the requirements?
-Lives in the Service Area (County)
-Have a valid Election Period
-Active A and B
Work Queue
Updating the Primary Care Provider after the effective date
Out of our Scope -
PES Tier 2 can update it prior to ED
Agent is able to update for the start of the next month in the BOB or with MS
01/14/2025: Educated active. tagee2
What is missing?
SR # and agent/contact information
What is the difference between Withdrawal and Cancellation of a application/plan?
Withdrawing will be when the application is pending
Cancelling is when the application has been approved
In order to enroll into a Dual (DSNP), what are the requirements?
-Lives in Service Area (county)
-Valid Election Period
-Active A and B
-Valid Medicaid for plan
What system can we use to look at a paper application or other missing documents received?
VIEW
Ordering a replacement ID card (The last one was requested more than 14 days ago)
In our scope -
We will verify the address and process new ID card
We can also walk agent to Book of Business if they have one in Jarvis
***Note the system will not allow us to order welcome kits so that will be MS for both PDP and MAPD
01/14/2025: per SR 123465798 AOR Bobby Brown WID 54321. tagee2
What is missing?
What was discussed/Updated
How are we able to see what plans are offered in a county?
Plan Search by zip code in Jarvis
In order to enroll into a Chronic Plan (CSNP), what are the requirements?
-Lives in service area (county)
-Valid Election Period
-Active A and B
-1 of the 3 Chronic Conditions
Cardiovascular disorders
Chronic Heart Failure
Diabetes
Why must we leave a notes in GPS?
It also assists later SSRs who will be able to see prior calls if the agent called back
Updating the address on an approved application prior to the Effective date
(update is only to the street address, does not impact City, State or Zip code)
In Scope with escalation to tier 2
If impacts service area or after the effective date will be MS
01/14/2025: per SR132456789 Bob CI on behalf of EE; EE requested the cancellation of (exact plan) for ED of 02/01/2025. Prior to ED, valid request processed. tagee2
Agent HIPAA
If agent provides us the missing information the day after the reply by date, but before withdrawal date - will we be able to process the application?
No, there are 2 days typically between the reply by date and withdrawal to give time in case info was received on reply by date. After, they will need to resubmit a new application
If an application is received for a plan and Enrollment is not able to verify the clients eligibility - what happens?
The application will pend and the will have until the reply by date on the AIL letter sent
Where are we able to reorder ID cards for clients?
Where would an agent be able to?
GPS under the Fulfillment Search and clicking Generate Replacement Materials
Book of Business in Jarvis
Questions regarding active member coverage such as claims, having issues at the Doctors office, etc
Out of our scope - MS
01/15/2025: per SR132456789 AOR Bobby Brown WID 54321 CI regarding status. educated approved and provided fulfillment shipped date. tagee2
Nothing is missing
When will we Manually Write a Letter to a client?
Withdrawals