Is Fixed amount that members must pay for medical services.
When a member is expressing a dissatisfaction what do we do?
Grievance
You must file a Grievance on each and every calls? True or False
False
Medicare is a Federal/Government program that provides healthcare coverage for people that are 65 or older and or people with chronic disabilities? True or False
True
What is 2N48?
Repeat caller within 48hrs.
This care focus on care, comfort and quality of life of a person with a serious illness who is approaching end of life.
Hospices
An Open Access Plan means?
A referral is not required by the PCP to visit a specialist
What is the meaning of D-SNP
Dual Special Needs Plans
What does AIS and NBA stand for?
Assistance in Scheduling and Next Best Action
What does the Quality Parameters/Attributes consist of?
Issue resolution, Connections, Compliance, Business Requirements
What is the Release rate Goal?
80%
People who have Medicaid and Medicare are not eligible for a Dual special needs plans? True or False
False
is the experience of understanding another persons thoughts, feelings and condition from his or her point of view. In other words it is putting yourself in others shoes.
Empathy
What is the Compliance Goal?
85%
What is a Deductible?
An amount an individual must pay for covered services before your insurance plan starts to pay.
What is the main purpose of the Initial Enrollment Period (IEP)?
Members enrolled in Medicare can start their application process for Original Medicare Program.
What is Co-Insurance?
Is a certain Percentage % that member is liable to pay for Covered services.
When does the AEP (Annual Enrollment Period) starts?
October 15th - December 7th
In which Stage does the Plan offers 100% coverage for all the medication's that the member is purchasing?
The Catastrophic Stage
Who is eligible for a Medicare?
Younger people with qualifies disabilities, elderly people over 65, Legal citizen or Permanent resident in US.
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