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Member Screens
Provider Screens
Function Keys
Plans
Misc.
100
These are the first things you check everytime you receive a call.
What the plan and term date.
100
You will check this screen to look up provider contracts.
What is PROVC
100
You will press this key to check notes.
F4
100
This plan requires the member to always select a PCP
What is the HMO plan
100
This is how you will answer all incoming calls.
What is Thank you for calling THPMP this is ....., may I have your member ID?
200
You will confirm this with a member on the HMO plan if they do not have there Member ID.
What is the PCP name
200
You will find the Dr's address on this screen.
What is PROVF
200
You will use this function key to look members up by name.
What is the F3 key
200
This plan allows members to go to any Dr as long as they are Medicare Eligible.
What is Group Med Supp
200
This screen will show you what the member currently owes for the monthly premium.
What is the PBLGR screen?
300
This field will show if the member is on more than one plan.
What is the Other Sub ID field?
300
You will check this screen to see where the Dr went to school or had his residency.
What is CREDL
300
You will use these function keys to order an ID card.
What is F6-C
300
This plan is for prescriptions and the member cannot have this plan with a HMO plan.
What is a PDP
300
This is where you go to first to check on member benefits?
What is the Evidence of Coverage (EOC)
400
You absolutely must complete this process everytime you receive a call.
What is HIPAA verification?
400
You will look in this screen in Diamond to see if the Dr is accepting new patients.
What is PROVF
400
You will use these function keys to check a member's monthly premium.
What is F6-4
400
This plan began January 2010 and it's only possible for member's to enroll in if they have are coming on through an Employer Group.
What is the Group Med Supp
400
These are the three prescription options that members have who are on the HMO plans.
What is No Rx, Rx and Rx Plus?
500
This field will show you the pharmacy plan, if the member has LIS or PA and possibly the medical plan.
What is the Rider field?
500
If a member would like you to search for a contracting PCP who is accepting new patients and within 10 miles of there home where would you look first.
What is the Provider Search Tool
500
You will use these function keys check on LEP.
What is F6-3
500
This plan requires member to live within a specific service area.
What is the HMO plan
500
These plans are new to Tufts Medicare Preferred as of January 2010
What is PDP and Group Med Supp?