A member calls in stating they believe their sales agent misled them about their plan when they signed up.  Which part classification would this call be documented under?

A member calls in asking how much a new medication their doctor prescribed will cost them.  Which part classification would this call be documented under?

MA-OEP NEW happens annually from January 1st to March 31st.

Change in residence, loss of Medicaid, and gaining Extra Help are all examples of which enrollment period?

The ICEP election period lasts a total of _____ months.

A member is able to disenroll from their CarePlus plan in the follow ways EXCEPT:

Talia calls into CarePlus on May 28th asking to change her PCP to a new doctor.  She mentions that she is not due for her next annual wellness appointment until September.  What action will you complete for the member?

When submitting a Retroactive PCP Change, the ICR must contact the PCP to verify:

An example of an Access Grievance would be:

A member calls with some questions about a letter he received from CarePlus.  He said the letter shows a list of visits to a chiropractor in town, but he has never been to a chiropractor in his life. You will take all steps listed below to assist the member EXCEPT:

A member's medication was denied last week as the doctor's notes did not show the member has tried the necessary medications in the step therapy first.  Since the claim has already been clinically denied, we are able to start a new EOC on the member's behalf.

Match the timeframes.

Shirley is on a fixed income. She calls CarePlus after learning she has been denied to receive Extra Help for her medication copays.  Shirley tells you she was happy to learn her authorization request for CarePlus to cover her Cosentyx was approved, but she doesn't know how she will afford to pay the copay. How can you assist Shirley?

A "Duplicate Therapy" rejection displays as ________ in both RxNova and PA Hub.

Formulary Exception EOCs can ONLY be faxed to the doctor.

In what screen can an ICR look up claim adjustment codes?

In what area of RxNova can you discover what stage of the Part D life cycle a member is currently in?

You confirm a member's authorization request has not yet been received by CarePlus. When you attempt to contact the provider, the office is close.  How will you assist the member?

If a member calls on the 12th day of a pending authorization and requests the determination be processed as soon as possible, you should:

When would we file an Expedited Grievance?