WellCare Jeopardy

Acronyms

100

CMS

Centers for Medicare and Medicaid Services

200

OOSA

Out Of Service Area

300

LOB

Line of Business

400

CHIP

_{Double Jeopardy}

Children's Health Insurance Program

500

IRMAA

Income Related Monthly Adjustment Amounts

_{Double Points : What is IRMAA?}

Call Drivers

100

'I have misplaced my ID card. Can you please send a new one to me?'

Material Request

200

A member is highly upset and would like it documented.

Grievance

300

Member wants to change their PCP.

PCP Change

400

'Why do I keep received automated calls from you? Please take me off this list.'

TCPA Revocation

500

Member wants an ANOC printed and mailed to them in Russian. 

_{Double Jeopardy}

White Glove Process

Definitions

100

Covers all Part A and Part B benefits; Provides plan cost-sharing equivalent to cost sharing under Medicare Parts A and B, but may be different for specific services; and includes an annual maximum out-of-pocket (MOOP) limit on total enrollee cost sharing (Deductibles, coinsurances and copayments) for Part A and Part B services. 

Medicare Part C

200

This is the part of Medicare that covers Doctors and Outpatient Procedures.

Medicare Part A

300

What are the 3 P's of being a Good Listener?

1. Polite
2. Professional
3. Patience

400

Putting yourself in someone's shoes and seeing things from their perspective.

Empathy

500

This occurs when providers bill members for the cost of services not paid by Medicare. 

Balance Billing

Authorization Forms

100

This authorization form grants permission to file an appeal, claim or grievance on a members behalf.

Appointment of Representative (AOR)

_{Double Points : How long is it good for?}

200

This is a legal instrument which grants another person the authority to make binding financial and healthcare decisions on the members behalf.

Power Of Attorney (POA)

300

This enables a member to have someone else speak on their behalf and discuss protected health information but can not make changes to the account.

Release of Information

400

This is a person named under a 'Living Will' to act on behalf of a member.

Health Care Proxy

500

A Power Of Attorney (POA) is valid for how long?

Until consent is revoked IN WRITING or the member becomes deceased. 

WellCare

100

What application is used to communicate with members and notate calls?

CAREConnects

200

How does Disenrollment happen? 

Voluntary : Member chooses to leave on their own.
Involuntary : Members are disenrolled because they are no longer eligible for coverage.

300

What resource do you use to look up Common Issues/Guides?

_{Double Jeopardy}

Central Point

400

What year was WellCare Founded?

1985

_{Double Points : Where are the WellCare headquarters?}

500

What is the LEARN formula?


_{Double Jeopardy}

Listen

Emphasize

Apologize

Resolve

Now