Key Terms
An interactive tool designed to support Advocates with First Call Resolution and provide an ongoing training resource.
What Is the Call Assistance Tool?
This is an individual who is granted, by the member, the right to discuss and/or receive the member's personal health information.
What Is an Authorized Representative?
The name of the group that provides health and well-being solutions to Medicare Beneficiaries?
Who is Medicare & Retirement (MR)?
Diabetes Screening, Medical nutrition Therapy, Glaucoma screening, Flu shots Etc.
What are some Preventative services?
You would select this option to send member materials such as:
Id cards
EFT Form
Welcome Kit
ETC
What is the send non marketing materials intent?
* holding on the line after saying good-bye to the member to avoid getting another call
*Leaving your immediate work area while your phone is in an Available state
* Inappropriate disconnection or release of phone calls prior to completing the phone call
What is Call Avoidance?
This Person is to act for the member in making financial and/or health care decisions as designated in this ____ document.
What is an POA?
*Integrity
*Compassion
* Relationships
* Innovation
*Performance
What are UHC Core values?
NON-Par
Non-contracted
Out of network (OON)
What are other names for Non-participating Providers?
Here advocates will be able to view memebers:
Copays
OOP Max
Deductible amount
What is the Review Medical benefits intent?
Information that directly relates of diagnosis. This information should NOT be provided to any callers, unless specifically listed in the "What can be Discussed After the Caller has been Authenticated" section of the caller type.
What is Sensitive Member Information?
An individual or organization authorized to manage and distribute those assets placed in trust pursuant to the terms of a Trust document.
What is a Trustee?
True or False?
The 5 Health states are:
*Normal
* Steady
* Managing Health Events
*Eventual Incline
*Care taking
FALSE !
* Wheelchairs
*Walkers
*Hospital beds
What are types of DME?
Here Advocates can View member:
Renew Awards
Answer general Inquires/Questions
What is the General Service Request Intent?
This was created in 1996, and addresses a number of issues, including the protection of confidential enrollee information.
What is HIPAA?
A person appointed/certified by a court to administer a deceased person's estate. An executor/administrator is authorized to act for the deceased person in all matters
What is a Executor?
The remaining portion that the member is responsible for paying before the plan takes over.
What is Coverage gap?
True or False?
Internal Medicine, Family Practitioner, Pediatrician, OB
Can be classified as a PCP?
TRUE
Here you can review Claim history
What is the Claim intent?
The process of determining whether someone is, in fact, who they declare themselves to be and they are authorized to access member information
What is Authentication?
A person (family member, friend, neighbor, etc) who provides unpaid assistance to help a member with daily living and/or medical needs. They may or may not live with the member
What is a Care-Giver?
October 15th - December 17th
When is the Open Enrollment Period?
This system is used to find member benefit information
What is IBAAG?
Here u can assign a member a PCP
What is the search and assign provider intent?