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little of everything nextgen Flashcards | StudBud
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little of everything nextgen
little of everything nextgen
40 terms
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StudBud Administration
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Questions
40
Answers
1
Dr. Thomas Winfield is listed as a Tier 2 provider. Is he Preferred?
False
True
2
When searching for members online, which website would you find a migrated Coventry member in?
Aetnamedicare.com
Innovationhealthmedicare.com
Allinahealthmedicare.com
Coventrymedicare.com
3
Mr Blank, calling because he is having surgery & wants to know if there is any follow up days with CPT Code 67840.
no days
5 days
2 days
10 days
4
Is this game Fun?
True
False
5
What is the member cost share to see a cardiologist?
Covered at 100%
$5.00
$0.00
$35.00
6
which of the following is not a payment option?
mail in the payment
Western Union
phone payment
EFT Deductions
7
What does Term mean?
married
details
disenrolled
deceased
8
What does Part D cover?
Dental
Vision
Transportation
Prescriptions
9
What is the members INN Max OOP?
$2764.82
$235.18
$3000
$4500
10
Where do you find the cost with a tier medication?
Map Tool
No where
Ask a Team Lead
ricki desk
11
Premiums are considered late after what date?
1st
10th
20th
5th
12
What does Part B cover?
Medical
work
rent
Nursing Homes
13
what is the required way to document benefits quoted in GPS?
check SR box
No documentation needed
copy & paste benefits info discussed from EOC
none of the above
14
What is a Medicare Advantage Plan?
Part E & F
Part A, B, & C
Part L, M, & K
Part D, J, & R
15
using GPS, what would you advise the member when they call about benefits on vision?
they have $300 limit for vision; used $0 remaining $300
they have $300 limit for vision; used $300 remaining $0
they dont have vision benefits at all
they have $2000 limit for vision; used $2000 remaining $0
16
EFT is ?
exercise for time
Everyday fun time
Eggs French Toast
Electronic Funds Transfer
17
Annual Notice of Change is also known as ?
EOB
EOC
ANOC
SOB
18
what is the cost for 30 day supply for Tier 2 medication at a preferred pharmacy?
$60
$0
$15
$20
19
LEP is going without prescriptions coverage for how long?
61 days
30 days
63 days
50 days
20
what is POA?
Plenty of assessments
power of attorney
practice on assessments
power of aetna
21
using image below, what is the members premium amount being deducted from SSA?
$17.00
$0
$11.40
$3.80
22
What is MOOP?
Something you eat
maximum out of pocket
my out of prescriptions
max of power
23
Members can see their claims online?
false
true
24
What is the members balance?
$7.60
$11.40
$3.80
$68.00
25
what is Mr. smith cost share on foot orthotics?
80%
100%
20%
50%
26
If the member is set up on SSA & wants to change to EFT what should the CSR do?
advise to call SSA
add bank account & send it off
add bank account & change pyt option in MP to EFT
nothing
27
Using cpt code: 67840; POS: ASC; prdct cd: HMO; Zip: 19132. What is the Approx MCARE rate?
$170
$121
$86
$129
28
how much has the member met towards their INN Max OOP?
$7345
$155
$5345
#5500
29
where do you check a members balance?
ECHS
HRP
ATM
MP
30
QUEST is Important
False
True
31
What does LEP Stand for?
low enrollment plan
Lazy egg pia
late everyday plan
late enrollment penalty
32
Only the Innovation Health plans have standard and preferred pricing for office visits.
False
True
33
What ways can a member pay?
Monthly Invoice
ATS
SSA
All above
34
What information is needed to update PCP in GPS?
NPI & Effective Dates
EPDB Pin and Effective Dates
Cap Office and Provider PIN
TIN & Effective Dates
35
What is LIS?
lipstick
low income system
listening skills
low income subsidy
36
SSD is?
Social Security Data
Social Security Deductions
Single Sign Off
Super Saturday Details
37
What are Open Enrollment Dates
10/15- 12/07
01/01-12/31
10/01-12/31
01/14- 01/31
38
what would the member pay for Ambulatory Surgical Center?
$0
$150
$40
$300
39
What does Part A stand for?
Hospitals
prescriptions
x-rays
food
40
In GPS what option would you select to view members benefits?
details
manage claims
member
explore coverage/benefits
