Generally covers hospital care, skilled nursing facility care, nursing home care, hospice, and home health services.
What is Part A?
100
The procedure in which the member may be required to try an alternative before this medication is covered.
What is Step Therapy?
100
Requirements for consumers to be eligible to enroll into an MAPD.
What is entitled to Medicare Part A and enrolled in Medicare Part B, must also live in the service area and must continue to pay their Medicare Part B premiums, must not have ESRD except in specific situations.
100
Dual SNP eligibility requirements.
What are members with Medicare Part A and B, enrolled in State Medicaid program, that live in the SNP service area, and do not have ESRD (unless under specific circumstances)?
100
The grey octagon, green triangle, red X and yellow square represent these respectively.
What is Available plan, Lead plan, Not recommended, and Caution - refer to plan overview?
200
The fee added to a member's part D premium if they do not have creditable prescription drug coverage for 63 or more consecutive days.
What is a Late Enrollment Penalty (LEP)?
200
The document in mySME that allows you to view copays and premiums for all three PDPs - including copays and premiums for members with LIS - offered in 2014.
What is 2014 PDP Standalone Plan Information - Benefit Levels?
200
All of the Medicare Advantage Plan types.
What is HMO, HMO-POS, (R)PPO, PFFS, SNP, and MSA?
200
Appropriate consumers to enroll in SNPs for whom the state pays cost share for Medicare Parts A and B and the federal government pays their drug premium through LIS.
What are QMBs or Full Dual-Eligibles?
200
Displays the phone number the call is routed from, the targeted product to discuss and the desired positive outcome.
What is call pop?
300
Eligibility requirements for Medicare.
What is age 65+, disabled and/or diagnosed with ESRD?
300
The stages of the member's prescription drug plan in the order in which he/she would experience them. (*For bonus points include dollar amounts for each stage in 2014!)
What is Deductible ($310 - member), Initial Coverage ($2850 - member and the plan), Coverage Gap ($4550 - member), and Catastrophic.
300
This describes any cost and coverage changes (services, premiums, copays, and/or coinsurance amounts) that will occur to a member's plan in the upcoming year.
What is the ANOC or Annual Notification of Change?
300
Conducted telephonically, a series of questions that asks the member about their health status and assistance they may need with daily living activities. Used by care management to define the risk level for each member.
What is the HRA (Health Risk Assessment)?
300
The screen that contains information on beneficiary's demographic info, current Medicare A and B eligibility, effective dates and LIS eligibility.
What is the Beneficiary Eligibility Screen in MARx?
400
The action you can take if you disagree with a coverage or payment decision made by Medicare, your Medicare health plan, or your Medicare Prescription Drug Plan
What is an appeal/file an appeal?
400
The basic description for Tier 1, Tier 2, Tier 3, Tier 4 and Tier 5 respectively.
What are Preferred Generic, Non-preferred Generic, Preferred Brand, Non-preferred Brand, and Specialty Medications?
400
The Scope of Appointment CMS disclaimer verbatim.
What is "When our licensed sales agent meets with you, they will be able to present all products and plans offered by UnitedHealthcare, which may include Medicare Advantage and/or Prescription Drug plans. Please confirm your agreement to this appointment"?
400
The qualifying chronic illnesses members may have one or more of to enroll into a CSNP (Chronic Condition Special Needs Plan)
What is cardiac arrhythmia, coronary artery disease, chronic venous thromboembolic disorder, peripheral vascular disease, chronic heart failure and/or diabetes?
400
The appropriate steps to take when contacting the language line.
What is Select the Language Line from the Carrier Redirect List in VCCD, Press 1 (Spanish) or 2 (all other languages), enter 9 digit employee or contract ID when prompted, explain situation to the interpreter, take note of interpreters name and ID, reconnect the consumer with the conference button.
500
The maximum amount a Medicare member will pay for Part B based on income.
What is $335.70?
500
The equation used to calculate the amount the member pays for a Late Enrollment Penalty (LEP). *For bonus points, roughly calculate a member's LEP for a 2014 plan if he or she went 16 months without creditable prescription drug coverage.
What is multiplying 1% of the "national base beneficiary premium" times the number of full, uncovered months the member was eligible but did not join a Medicare drug plan and went without other creditable prescription drug coverage. The final amount is rounded to the nearest $.10 and added to the member's monthly plan premium. BONUS: $5.30-$5.40 LEP will be owed in addition to member's premium.
500
What is the Out-of-Pocket Maximum for the UnitedHealthcare MedicareComplete (HMO) in Clark County, zip: 89054. *For bonus points, include copayments/cost sharing for all tiers in Initial Coverage using OptumRx.
What is $2500.00? Bonus: Tier 1: $0 Tier 2: $10 Tier 3: $104 Tier 4: $275 Tier 5: 33%
500
Consumers who have lost Part A benefits due to returning to work, but are eligible to enroll in and purchase Medicare Part A and have an income of 200% FPL (Federal Poverty Line) or less and are not otherwise eligible for Medicaid.
What are Qualified Disabled and Working Individuals (QDWIs)?
500
The tab in bConnected that can be used by the agent to track leads and/or the progress of leads on a call.