DUALS
A call driver we use when a duals member received an incorrect bill.
What is Balance Billing?
The Central Knowledge Base for Wellcare/Centene in which agents can find and save paths.
What is Central Point?
This allows member to receive an allotted amount of items each month or quarter.
What is Over The Counter?
Post Call Next Steps
This teammate fell on the flat floor, causing a knee to slam into and dent a cabinet. :)
Who is Momma?
The period in which the member is able to enroll, disenroll, or complete a plan change.
What is Annual Enrollment Period?
The system KY agents must check to verify a name change.
What is KYMMIS?
This allows members to receive rewards for completing some Preventive Services.
What is Member Incentive Program or Healthy Rewards?
Ensuring you have resolved all member concerns and questions?
Confirming Member Satisfaction (Is there anything else I can help you with today?)
This team mate claims to be the manliest man of them all, loves Jack and Coke, and aspires to take the #1 spot on our team! :D
Who is Shawn?
This allows members to enroll, disenroll, or complete a plan change outside of the annual enrollment period due to a special circumstance.
What is Special Enrollment Period?
Here, agents can view material that has been mailed to member by Wellcare.
What is CSE
These are given by states to measure skills and knowledge similar to a high school course of study and is a benefit with a $0 copay for most KY Medicaid Plans.
What is GED?
Requiring validation such as DOB, address, or third parties on file?
Verifying HIPPA
This Team Mates enjoys Christian the wrestler, avoiding the public at all cost, and kicking the back of chairs. :)
Who is Mike?
This is the path we use to find the contact information for vendors in a particular state.
What is Medicare Advantage (CCP) Vendors by State - Quick Hits?
This system allows agents to verify which benefits are included or not included in a members plan.
What is Sensentia?
This benefit ensures members stay healthy with these proactive and routine visits.
What is Preventive Screenings?
Utilizing systems such as Central Point, CSE, and COS when researching a member's issue.
What is Command of Company Resources?
This team mate has visited the Gateway Arch in St. Louis and is so funny, could probably go into stand up comedy!
Who is Dylan?
This is the process used when a member is expressing dissatisfaction with the plan, doctor, etc. on duals or any other LOB
What is Grievance?
This system allows agents to view things like Medication Claims and Benefit Stage Accruals.
What is COS?
The plan's coverage of a designated portion of a member's Part B premium.
Part B Giveback
Delivers reason for the call
What is Consultative Transition into the next phase of interaction? (We are working in conjunction...)
This team mate's mind is always in the gutter and will twist any comment into a comment that will you make you blush!
Who is Wendi?