Weekly Development Test (The Money Team)

Blue Essentials plans are ___ plans.

• PPO

• EPO

• HMO

• CDHP

We can accept member's credit card information to set recurring drafts over the phone.

• True

• False

What information is needed for a Medicare Entitlement Appeal?

• The member would call and tell us their Medicare status.

• We would need a letter from Medicare or Social Security Administration confirming the member's Medicare status.

• Medicare would need to call and confirm Medicare status.

Which screen would you use to view an individual claim?

• RMME

• RMIH

• RMIM

• RMPG

All of the Blue Essentials Plans are Health Savings Account (HSA) eligible.

• True

• False

A breast biopsy does not require precertification.

• True

• False

Can the member purchase a CPAP machine without going through the rental process?

• No, CPAP machines are only purchased through a 10-month rent-to-own process.

• Yes, the member can get the CPAP machine as a one-time purchase.

A member has paid their premium in full but their pharmacy benefits are still on hold. What should you do?

• Call Pharmacy Support and tell them to remove the hold.

• Email marketplace.escalations a screenshot of FIPS showing where the member made their payment and ask if the hold could be removed.

• Call Caremark and ask if they could remove hold.

• Email marketplacepharmacy a screenshot of FIPS showing where the member made their payment and ask that they remove the hold.

We are needing the Medicare Entitlement information for a member to process their claims. How would they submit it?

• Email to Membership.Enrollment

• Fax to 803-870-9439

• Mail to PO Box 100228, Columbia, SC 29202

• All of the above

• None of the above

The member's policy cancelled effective 07/01/19. She was left with a balance of $382.64 for 06/01/19 and has signed up for a new policy for 2020. Would the member have to pay the outstanding balance before her new policy becomes effective?

• Yes

• No