Knowledge Central

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Across
  1. 2. During this phase of coverage, the member is responsible for 100% of their drug costs for tiers that the deductible applies to until the deductible amount is met.
  2. 4. Advocates are not allowed to enter a ______, term an account due to death, or request a disenrollment letter be sent.
  3. 7. The program is designed to educate and help our members be proactive about their health. This visit is meant to support the care the member receives from their primary care provider. It does not replace their regular PCP visits or the annual wellness exam.
  4. 10. In most situations, you should not voluntarily offer to submit a _____ if the member has not made the request and if you have not provided additional resources for the member. However, there may be a few exceptions, such as: Members with a limited supply of Part B drugs Members with an upcoming provider appointment Members that have made multiple attempts at a resolution without success
  5. 12. vendor shows up without personal protective equipment (face masks)Which Job aid under Wellness Benefits?
  6. 13. system is used to look up specific information CMS has on file for a caller's Medicare benefits.
  7. 15. Coverage is the period after the member has met the True Out Of Pocket (TrOOP) cost for the benefit year.
  8. 16. activation period is good for up to nine consecutive months of travel and services include all plan benefits covered within the plan service area, including preventive care, specialist care, hospitalization and optional supplemental benefits (riders).
  9. 17. Coverage is the period after the deductible has been met and the total drug cost is less than the Initial Coverage Limit.
  10. 18. helps people with Medicare pay for prescription drugs, and lowers the costs of Medicare prescription drug coverage
  11. 19. is the period between the member meeting the Initial Coverage Limit and prior to meeting True Out of Pocket (TrOOP) cost. In this level of coverage, the member is responsible for a percentage of their drug costs.
Down
  1. 1. PCP change requested between 1st and 24th: Standard effective date will be the 1st of the following month (i.e. PCP change request received on 4/21. Standard effective date will be 5/1).(STATE)
  2. 3. System we use to see out of pocket and Coordination of Benefits
  3. 5. is the web-based system for viewing documents and requesting re-prints of Explanations of Benefits (EOBs), System Generated Letters, and Billing Statements that we send to members.
  4. 6. Includes iFOBT and Cologuard in-home screening test kits.
  5. 8. Determination is a decision about Part C payment or benefits, or the discontinuation of health services that the member believes they are entitled to.
  6. 9. The caller will need to contact the member’s local _____ office to advise them of the member’s passing.
  7. 11. member requesting reimbursement for services they paid up front whether in or out of country.
  8. 13. When you are making this change the end date to be open-ended, use 12/31/9999 for the end date.
  9. 14. Is the issue with the member’s name not matching? Who would you call to send letter?