parts of Medicare
helps pay for Hospital visits and if admitted in the Hospital
What is Part A?
list of the drugs that are covered by the plan. This list tells you the drugs class, tier and status of covered or not
what is formulary
Member, Plan, Employer Group, Application, Recent Interactions and Alerts/Triggers information.
what is summary 360
set amount the member must pay before being seen by doctor/specialist
what is copay
Medicare members qualities
what is 65 & older, disabilities, and end stage renal disease
helps pay for copays, doctor visits and you pay little to nothing out of pocket
What is Part B?
MRI, CAT scan, hospital stay, durable medical equipment, medical supplies, OTC, gym (fitness), healthy foods
what is review medical benefits?
required to be presented to callers, some are grey others are gold: flu reminder, email verification, etc.
what is NBA
percentage the member must pay for a service/medical equipment
what is coinsurance
pay for Part D premiums and medications. The member will have a set copay/coinsurance for their part D drugs only with their assistance.
what is LIS
cover prescription drugs
what is part D?
if a member is calling about a denial/information about a doctors visit/hospital stay, and/or reimbursements for services completed already.
what is review claim history
A plus B=_____ with some extras like: dental, vision, transportation, etc
what is part C?
check error messages here to see why a member could not get their medication
what is claim history
to be considered for UHC Medicare Advantage plan they must have what
what is Medicare part A & B
must be used and done on every single call to ensures everyone will know exactly what you and the member discussed
what is an intent/documenting
this is a penalty the member must pay, administered by SSI, if they don’t obtain Part D coverage
What is LEP?