Out of Scope Plans

What plans are considered as Out of Scope plans. (Select all that applies)

• Medicaid Policy

• DSNP Policy

• Medicare Policy

• Commercial Non-Offshorable Policy

If a member's carrier name has Medicaid indicator, what queue should it be transferred to?

• CLRX_AHD_PAT_Transfer

• CLRX_AHD_PAT

• CLRX_AHD_PAT_Medicaid

What specific tool do we utilize to determine if the policy is Medicaid, GRS or DSNP?

• PST

• COS

• ERx

• One Note

What does DSNP stands for?

• Dual Selection Needs Plan

• Dual Social Needs Plan

• Dual Special Needs Plan

• Dual Specification Needs Plan

What does GRS stands for?

• Group Resolution Selections

• Group Retiree Solutions

• Grievance Resignation Solutions

What specific queue do we transfer GRS and DSNP plans?

• CLRX_AHD_PAT_Transfer

• CLRX_AHD_PAT

• CLRX_AHD_PAT_Medicaid

• CLRX_AHD_PAT_Transformers

Offshore associates are not allowed to handle these policies and they need to transfer the call to the Dedicated queues

Sample Group Name: Kroger

• Commercial Offshorable group

• Commercial Non-offshorable group

• GRS policy

• Medicare Policy

What specific information do we need in order to identify if a plan is a Commercial Non-offshorable group?

• Group name

• Member ID

• Termination date

• Group ID

What is the transfer queue for Commercial Non-offshorable groups?

• CLRX_AHD_PAT

• CLRX_AHD_PAT_Transformers

• CLRX_AHD_PAT_Medicaid

• CLRX_AHD_PAT_Transfer

What Plan would this Group name be considered as?

Group Name: CA GRS LABORERS HW TRUST

• MEDICAID

• DSNP

• GRS

• COMMERCIAL NON-OFFSHORABLE