Premium
What are 3 methods the member can pay their premium?
Billing statement, EFT, SSA
What are the parts of the 3 part start
Acknowledge &
Reassure
What is another name for A4me
Next Best Actions
Where in maestro do you go when the member is calling about a claim?
Review claim history Intent
You must do Hippa before doing your 3 part start ?
False- as an advocate you must always do your 3 part start before accessing member account information
What intent in maestro do you go to for LEP questions?
Manage LEP
If the member is calling and did not auto populate, what must you verify ?
Member full name, Date of birth, AND member's id OR member's address
What metric must you meet for delivery and assist rate?
80% & 17%
What information must you get from the member before search for a claim?
Date of service, Who the bill came from, Amount of the bill, Billing number on the bill,
We as advocate can remove LEP for members as long as they had creditable coverage
False only Maximus can remove and reconsider any LEP decisions
When does the member get billed for premium
On the 1st of each month.
When must you do your 3 part start ?
At the very beginning of the call before HIPPA
What is the definition of Next best action?
Next best action are personalized life saving opportunities
What drop down in Doc360 do you go to when trying to find a claim
M&R EOBs
An authorized representative can update and change member account information at anytime
False - Advocate must obtain verbal authorization from the member before making any changes
Where do you go to view any bill UHC may have sent the member ?
Doc 360 GPS billing invoices
If an authorize Representative is calling, what must you verify from them?
Member full name, date of birth, member id OR member address, along with authorized representative Full name and relationship to member
How would you disposition if the member indicated they have already had their Annual Wellness Visit?
Member schedule/complete and need to put in appointment time and date.
What tool do you use to search for denial codes on claims ?
Macro
United Healthcare never bills the member for anything besides their premium
True
When assessing a potential LEP, CMS reports if a member has had a lapse in prescription coverage that is greater than ? days.
63 days
Demonstrate 3 part start with you acting as the advocate and instructor as member
MUST ASK ACKNOWLEDGE AND REASSURE
Which of you next best action counts towards your assist rate?
Annual Wellness, Breast Cancer, Colorectal, Diabetic eye exam, Diabetic blood sugar, Diabetic Kidney, Housecalls, Rheumatoid Arthritis
What is a provider write off and does the member pay bill?
No, provider write off means the provider office billed us over the Medicare contracted rate and should not be billing member for remaining amount but instead must just take their lost.
Anytime that you schedule a doctor appointment for the member your assist rate will rise up
False - it must be a next best action in order to be consider an assist