Test Your Knowledge

Eligibility

100

Hows do off exchange members cancel their coverage?

In writting: 

UnitedHealthcare Individual and Family Plan
P.O. Box 30753
Salt Lake City, UT 84130
Fax: [phone]

200

Who do we connect NY & MA members with to enroll in stand alone dental/vision?

If the caller does not have vision or dental benefits through IFP, they can purchase a standalone plan with UHOne (also formerly known as Golden Rule).

300

How does an off exchange member enroll into coverage?

Do NOT transfer NY and MA Off-Exchange members to UHOne Telesales, as they won't be able to help them, instead advise to go to shop.uhcexchange.com.

400

How can CO,NJ and WA members enroll into Safetrip coverage?

SafeTrip is not yet available for residents of Colorado, New Jersey, New York, or Washington

500

What are the qualifying event examples for Special Enrollment Period? (SEP)

• Loss of qualifying health coverage
  Note: Member must have lost coverage in the last 60 days or expects to lose coverage in the next 60 days.
• Change in household size:
  • Marriage
  • Birth of child
  • Death
• Change in residence or income
• Change in status:
  • Gained citizenship or lawful presence in the U.S.
  • Release for incarceration (detention, jail, or prison)

Payments

100

Where do NM members make their Premium payments?

 Plan Year 2026 - NM On Exchange members will make premium payments with UHC directly.

200

Where would MI members mail there premium payments?

MI only: 

UnitedHealthcare
P.O. Box 630625
Cincinnati, OH 45263-0625

300

What do we provide if member is requesting Confirmation number for payment?

 If the member is requesting a confirmation number for their payment, provide the S-case number from Maestro.

400

If the member disagrees with balance amount after review what SOP should you locate?

Review the members Billing Overview, Invoice History, and Payment History as applicable with the caller.

If the member still disagrees go to Premium Payment Discrepancies for process steps.

500

What must members do if they are termed for non-payment?

They must contact the MarketPlace or visit shop.uhcexchange.com to see if they qualify for a Special Enrollment Period (SEP) or wait until Open Enrollment Period

Hipaa

100

In an Emergency Situation what information must be authenticated?

• Member information
  • First and last name
  • Date of birth
• Caller information
  • First and last name
  • Relationship to member (e.g., executor, trustee, guardian)
    Tip: In Maestro, check the Authorized Reps field in the Member Details banner to identify any authority.
  • Type of emergency

200

What information can be discussed with an internal caller after authentication?

• Basic plan Information
• Member enrollment information
• Member claims information
• Member medical information
• If requested:
  • Verify member's demographic information (e.g., phone number and address).
  • Provide information on the member's authorized parties on file.

300

In what KM does it list that utilizing a nickname similar to the members name is an acceptable authentication?

KM1783351 - HIPAA Guidelines for all callers

400

What documents can be mailed to a members POA?

All documents intended for the member, or which they would normally receive, can be mailed.

500

Where can an attorney submit their request for enrollee information?

Must be submitted in writing to 

UnitedHealthcare
PO Box 29135
Hot Springs AR 71903

Member Mateials

100

What is the TAT for replacement ID cards?

7/10 business days

200

What states require QHC letter?

Only the state Michigan 

300

When does member receive Proof of loss coverage letter?

The member should receive the letter within 10 calendar days of the date UHC was notified of the termination. 

400

What is the TAT for member reimbursement forms?

After submitting the form, allow 30 business days for processing.

500

whats included in the welcome kit?

• Non-Discrimination Notice
• Welcome Sheet
• Walgreens Smart Savings Card
• Medical ID Card: For subscriber and dependents
• Creditable Coverage Notice: Important notice about prescription drug coverage and Medicare
  Note: Applies to members who have Medicare or who will become eligible for Medicare during the plan year. 
• State-specific Non-discrimination Notice: For Washington members only
• Sales Agent Commission Notice: Only for members enrolled through a sales agent

Claims

100

What is the Network prefix for IFP?

EXGN

200

What are some examples of balance billing?

• Members receiving bills from in network (INN) providers
• Claims for services covered by a gap exception
• Members who are being balance billed as the result of:
  • Emergency services from an Out of Network (OON) provider.
  • Out of Network Radiology, Anesthesiology, Pathology, Lab (RAPL) at an in-network facility.
  • Air Ambulance
  • Ground Ambulance in: CO (by private providers only), FL, IL, MD (by public providers only, like fire departments), OH, TX
  • Non-office based labs/x-rays (NOBLX)

300

What is the name of the service form used to submit claim adjustment?

 CSP-Claim Adjustment Request Service Form.

400

What is the TAT for claim adjustment to be reviewed?

10/15 days 

500

Where do providers send claim submissions?

• Electronic claims: EDI (Electronic Data Interchange): Providers should use the EDI 837 Health Care Claim transaction. The payer ID is 87726.
• Paper claims:
  UnitedHealthcare
  P.O. Box 5290
  Kingston, NY 12402