Which stage of coverage is referred to as the "donut hole" as the member is paying the most for drug coverage: Noting the correct enrollment period on enrollment applications helps in preventing delayed enrollment processing: Which of the following actions are you required to do when contacted regarding an allegation of noncompliant activity? {' (P0=X8%o9" :bt!.}C]8Bn h)?]m/ZNHi1rtt=@lN: yY\$di+>m9kj1lu).Sbog?Q.Cn[:~ !2 }`!msT6AvrclV/ccus|#2iW8e|eODF8RnW@gI53u2yPY6j=M7^vk?g).Ky>NXQd6jZ[ii3eQe,?\7_VwW;B"y?{{>{~0 )Im lock All those reasons we previously covered on why its important to stay compliant when holding a Medicare educational event? Heres how you know. If the physician has obtained prior authorization or advance notification, the initial day of the inpatient admission will be paid, unless: If advance notification is obtained but is not made by the facility in a timely manner, payment reductions will be limited to hospital room and board charges, when applicable. They fit here as well. Submit the event cancellation to all carriers involved or your upline, Be present, or have a plan representative present, on site at the original start time to let potential attendees know about the cancellation and provide them with plan information (unless the cancellation is due to inclement weather), Remain, or have the plan representative remain, on site at least 15 minutes after the original start time, Tell potential attendees about the canceled event the same way you let them know about it (If you cannot, you must provide proof substantiating that to all carriers involved). CMS Issues Final 2024 Rule: What You Need to Know, Senior Market Sales Acquires Sizeland Medicare Strategies in Latest Strategic Growth Move, Senior Market Sales Acquires O'Neill Marketing in Latest Strategic Growth Move, Milestone Secure Act 2.0 Is Major Boost for Your Clients' Retirement And Your Career, Senior Market Sales Acquires The Buckley Insurance Group as Part of Strategic Growth Plan, SMS e-Ticket - Online Term Life Submissions in Less Than 10 Minutes, Healthcare Begins Here Retail Program at Walmart Stores, Make Sales to Seniors While Eliminating a Gap in Medicare Coverage, Discussing any options, rates or benefits for the next plan year on phone calls or at an appointment, Holding sales/marketing events where options for the next plan year will be discussed. Agents must report all sales/marketing and educational events to the Sales and Marketing Support Executive (SMSE). On the date the preauthorized or approved service was delivered, the member was not covered by UnitedHealthcare, and the care provider could have verified the member's eligibility status by using UnitedHealthcare's automated eligibility verification system (VETTS). Study with Quizlet and memorize flashcards containing terms like A grievance request, or any evidence concerning a grievance, must be filed orally or in writing no later than _____ calendar days from the date of the event or the date the member is made aware of the issue., When completing an application, you should ensure that you enter the provider ID of a specialist and not a Primary Care . hb```f`` P ,@Q LN.``5 Li|SRRQlURx~hhEGG0d``3Y@$q`\(Meg*#r,lb ;4*Z10Xe=b|!&S@0W{ @J)G Z3 Dont forget, during your event, you may unknowingly speak with a secret shopper. To this end, The Health Plan initiates activities and processes when a member requires inpatient care. All Wellcare standalone PDP plans will have a $0 Tier 1 preferred retail and mail benefit: Any request or distribution of PHI should contain only the minimum amount of PHI required to complete the intended task. Submission Deadlines: A grievance is an expression of dissatisfaction (other than an organization determination) with any aspect of the operations, activities, or behavior of a Medicare health plan, or its providers, regardless of whether remedial action is requested. Which of the following statements about Scope of Appointment (SOA) is FALSE? Not everything goes as planned. Privacy Policy. Which of the following is not a Wellcare quality driver? through innovation. All standalone PDP formularies have a ___-tier structure for 2022. But, if the beneficiary is entitled to another enrollment period, like a Special Election Period (SEP), or if they are in their initial eligibility period, continue to operate as normal. How many executive committees are possible? Insurance coverage provided by or through UnitedHealthcare Insurance Company or its affiliates. x[K1NnThmZ;]n/C2$Na^RD;";*=|O &)N`T ;Xngzt_k)"IQB~pfI^%69ZXwp+s-,#nN$S6yZO[O];KU\PsVA5cPRZu/;h\`8.vmg2.WTte07TxiMhqU/n%c7h To file an appeal by phone, call 1-877-389-9457 (TTY 711 or 1-877-247-6272 ). 17K views, 519 likes, 455 loves, 3.7K comments, 232 shares, Facebook Watch Videos from EWTN: Starting at 8 a.m. When completing an application, you should ensure that you enter the provider ID of a specialist and not a Primary Care Physician (PCP). Steps to take when safeguarding and securing PHI and PII include, An agent may be terminated for cause if they fail to comply with a compliance investigation, encourage others to avoid the compliance interview process, or fail to provide truthful or complete information, For 2022, ______ will no longer be a preferred pharmacy, The Part D Senior Savings Model (SSM), which reduces member spending on insulin, will be offered on the Value Script and Value Plus products, Agents must meet all required contracting, training, and certification requirements to be eligible to sell Wellcare's Medicare Products. You can ask us to . stay compliant when holding a Medicare educational event, strategies to grow your insurance business, Rules for Hosting a Compliant Medicare Educational Event, What Not to Say During Medicare Educational and Sales Events, Notify attendees of when your sales event begins, if your event follows directly after an educational event, and give them the opportunity to leave, Let beneficiaries approach you first at informal events, Offer health screenings or similar activities that could seem like, or be used for, cherry picking, Use sign-in sheets that clearly indicate providing contact information is, Name all products and plan types youll cover before starting, Compare one carriers plan to other carriers plans by name without getting written consent from all carriers involved in the comparison or without having studies or statistical data to back up comparisons (Comparisons must be factually based and cant be misleading), Use only carrier- and CMS-approved presentations and talking points, Discuss or cross-sell non-health care related products (e.g., annuities, life insurance), Distribute giveaways with your contact information on it, Use absolute or qualified superlatives (e.g., This is the best plan! If a drug is not covered or there are restrictions or limits on a drug, you may request a coverage determination. Use online event reporting tool. Heres how you know. website belongs to an official government organization in the United States. To download the NOMNC and DENC,please click on the appropriate link below in "Downloads". endstream endobj 699 0 obj <>stream The Part D Senior Savings Model (SSM), which reduces member spending on insulin, will be offered on the Value Script and Value Plus products. hbbd```b``V+@$>.J`>0)&e@$Kd RDrG(m AdH%c!;#]ADg` r A coverage determination (exception) is a decision about whether a drug prescribed for you will be covered by us and the amount you'll need to pay, if any. A city council with eight members must elect a three-person executive committee consisting of a mayor, secretary, and treasurer. Include agent name, NPN, agents phone number, date of event. Returns a Notification object representing the notification that was clicked to fire the event. Wellcare uses cookies. Check the carrier's website/portal for the most current procedures. When creating ads or invites, you cannot require potential attendees to provide contact information to RSVP for the event. Cigna employed agents must contact their manager. Reporting template and e-mail address: ) 09-70-0588. . Upon certification, access to the Single Sign-On Portal, Agent Connect (Broker Portal) and Custom Point (Materials Ordering) broker resources is gained. A federal government website managed and paid for by the U.S. Centers for Medicare & Medicaid Services. Not registering an event in time with one of them will force you to reschedule it. NotificationEvent.action Read only . A Detailed Explanation of Non-Coverage (DENC) is given only if a beneficiary requests an expedited determination. The agent of record will not remain with the member after the consolidation. In contrast to TQM, this approach seeks radical change Inherits properties from its ancestor, Event. Please contact Medicare.gov, 1-800-MEDICARE, or your local State Health Insurance Program (SHIP) to get information on all of your options.. Wellcare has streamlined standalone PDP offerings from six plans to ___ in all 34 regions across all 50 states and D.C. This event is not cancelable and does not bubble. To ensure accurate data entry, you should repeat the Medicare ID back to the beneficiary. .gov Bleach_______ Tea _______Cream _______Cola _______. Note: Any event not advertised as educational can be viewed as a marketing event and should be registered as one. Sales and educational. It has been updated to include information more relevant to the 2023 Annual Enrollment Period. The NOMNC informs beneficiarieson how to request an expedited determination from their Beneficiary and Family Centered Care Quality Improvement Organization (BFCC-QIO) and gives beneficiaries the opportunity to request an expedited determination from a BFCC-QIO. Enable JavaScript to view data. Notification of events must be received by Wellcare. Quality of care grievances (complaints about the quality of care received in hospital or other provider settings) may be reported through the plan's grievance procedures, the enrollee's Beneficiary Family Centered Care - Quality Improvement Organization (BFCC-QIO), or both. or You must register sales events with the proper parties and hold them in a public setting where individuals do not receive health care services. To meet these fundamental requirements, be sure to schedule your event far enough in advance to reserve a suitable space and let everyone know about it. %PDF-1.5 % Currently we represent [insert number of organizations] organizations which offer [insert number of plans] products in your area. The required lead time for reporting your event varies from carrier to carrier, so register your event as soon as possible. Sometimes, we do not meet your expectations, but we would like to try to resolve your issues. We would like to take this opportunity to inform you that effective 6/13/2019, there will be an increased focus on ensuring that our providers follow our notification requirements as stated within your provider manual. Agents may not market to members receiving Service Area Reduction (SAR) Notices until October 2. The DENC explains the specific reasons for the end of covered services. All informal marketing and educational events, report to SMSE at least 7 days in advance of the event date. .gov Which stage of coverage is referred to as the "donut hole" as the member is paying the most for drug coverage? Educational events may or may not need to be reported to the carrier. Are you considering holding a marketing event to get the attention of more Medicare clients? Physicians, health care professionals and ancillary care providers are responsible for providing advance notification. A grievance request, or any evidence concerning a grievance, must be filed orally or in writing no later than _____ calendar days from the date of the event or the date the member is made aware of the issue. Notification should be submitted as far in advance as possible but must be submitted at least five business days before the planned service date (unless otherwise specified). A copy of the model notice plans may use to notify enrollees about their right to an expedited grievance can be found at Notices and Forms using theleft navigation menu on this page. Agents may not market to members receiving Service Area Reduction (SAR) Notices until October 2. This includes all admissions, including admissions to behavioral health facilities. : Prior to advertising or 10 calendar days prior to the event, whichever is earlier. Visit Mozilla Corporations not-for-profit parent, the Mozilla Foundation.Portions of this content are 19982023 by individual mozilla.org contributors. Avoid sales activities at health fairs or expos where health screening is being provided to avoid the risk of being perceived as engaging in cherry picking.. endstream endobj 695 0 obj <>/Metadata 54 0 R/Pages 692 0 R/StructTreeRoot 85 0 R/Type/Catalog/ViewerPreferences<>>> endobj 696 0 obj <>/MediaBox[0 0 960 540]/Parent 692 0 R/Resources<>/Font<>/ProcSet[/PDF/Text/ImageB/ImageC/ImageI]/XObject<>>>/Rotate 0/StructParents 0/Tabs/S/Type/Page>> endobj 697 0 obj <>stream Event Reporting Do you need to register sales events? Wellcare By Fidelis Care strives to provide high quality care and service to our Medicare Advantage and Dual Advantage members. Sign up to get the latest information about your choice of CMS topics. https:// Wellcare has added ____ new counties to our footprint in 2022. ", Notice of Medicare Non-Coverage (NOMNC) Forms (Incl Large Print)- English and Spanish (ZIP), Detailed Explanation of Non-Coverage (DENC) Forms (Incl Large Print)- English and Spanish (ZIP), Instructions for Notice of Medicare Non-Coverage (PDF), Instructions for Detailed Explanation of Non-Coverage (PDF), Chapter 30 - Financial Liability Protections (PDF), Parts C & D Enrollee Grievances, Organization/Coverage Determinations, and Appeals Guidance (PDF). Additionally, you must include the following disclaimer on all advertisements and invitations for your event: For accommodation of persons with special needs at sales meetings call .. California and Washington providers, hospitals and other acute inpatient facilities are subject to the admission notification requirements described in the UnitedHealthcare Administrative Guide. Wellcare's quality focus consists of six drivers. Getting to know all your carriers reporting requirements is important. Wellcare must receive notice of an event change or cancellation as soon as possible, but no later than 30 mins after the event start time. A grievance request, or any evidence concerning a grievance, must be filed orally or in writing no later than _____ calendar days from the date of the event or the date the member is made aware of the issue. Reporting template and e-mail address: Sales Event Log Templates and the Sales Event Form are available from the Cigna manager/BSR. During this AEP season, please remember that in order to stay compliant with the CMSMedicare Communications and Marketing Guidelines, all sales/marketing events must be registered properly with each carrier. At least one week before the event. Inpatient Admissions: WellCare requires notification by the next business day when a member is admitted to a facility. Educational and Marketing/Sales Events must be conducted in accordance with CMS's Medicare Marketing Guidelines which specify requirements related to sales and marketing activities, including event reporting, locations, materials, and gifts/promotional items. Communication of PHI can be: Select all that apply. If prior authorization or advance notification is needed for the requested elective inpatient procedure, it is the physician's responsibility to obtain the relevant approval. A NotificationEvent. For weekend and federal holiday admissions, the notification must be received by 5 p.m. local time the next business day. 9 essential traits of a good husband. Content available under a Creative Commons license. Reporting template and e-mail address: xy| W4Do""4 ( EOE[kUK--*HU- *bd_ncrsr#3g~s{3wllAAAAAAAAAAAAAAAAAAAAAyA>PTpTcw8Vt:xvZ UAcuwa;mCg@xAA While the Medicare Advantage & Part D Communication Requirements dont require you to submit sales event cancellations in HPMS, you should follow the best practices below and any policies set forth by your carriers. If a drug is not covered or there are restrictions or limits on a drug, you may request a coverage determination. 0 ( Submit the Sales Event Log Template prior to the 15th of the month for the following month's events. hS]O1+^! Note, you may carry out sales activities in common areas of health care settings, including common entryways, vestibules, waiting rooms, hospital or nursing home cafeterias, and community, recreational, or conference rooms. Reporting template and e-mail address: If you have questions about this article or other compliance questions, please contact our compliance department, or ask your marketer. You can decide how often to receive updates. Which standalone Prescription Drug Plan is best for "dual-eligible" members? My Blog notification of events must be received by wellcare Grievances. a drug that requires prior approval. %PDF-1.5 % TRUE Wellcare has expanded coverage in Massachusetts, Nebraska, and Oklahoma. Here's what sets them apart: Formal Sales Events: Agent presents plan-specific information to an audience invited to the occasion. Wellcare PDP is consolidating from six plan offerings to three plan offerings for 2022. Chapter 7,8: vertebrae and spinal curvatures, Information Technology Project Management: Providing Measurable Organizational Value, Operations Management: Sustainability and Supply Chain Management, John David Jackson, Patricia Meglich, Robert Mathis, Sean Valentine, Organizational Behavior: Managing People and Organizations, Jean Phillips, Ricky W. Griffin, Stanley Gully. Medicare Star Ratings and performance are at the forefront of Wellcare's quality strategy. Sometimes you may have to cancel your sales event. hb```VfVAd`a`b MXEMX9`0`p85WmJX %/51Vbyaw "/e,:"t+~@)Pl'I,=R 0vE' HQQLw0Ut4wt0 ;dCDB*`AW$Ag@>f0j iQ?4 $q+70wP|p!24rB[Fm[?0 20 6oP endstream endobj 335 0 obj <. // This looks to see if the current is already open and. hbbd```b``dd&v$=G\A@D0 C> Outside of work, she loves spending time with her husband and two sons, vacationing at the beach, and playing volleyball or Catan! For more information about filing a grievance with the BFCC-QIO, click on the link to the Medicare publicationMedicare Rights and Protections under the "Related Links" section below. %%EOF Identify the INCORRECT statement regarding the plan consolidation. Verbal permission granted to discuss plan details qualifies an authorized representative to complete an application on behalf of the beneficiary. An official website of the United States government You can decide how often to receive updates. Which of the following is not an example of Protected Health Information (PHI)? *\ Each plan must provide meaningful procedures for timely resolution of both standard and expedited grievances between enrollees and the Medicare health plan or any other entity or individual through which the Medicare health plan provides health care services. What type of events need reported: If a client calls you about their Annual Notice of Change (ANOC) or Evidence of Coverage (EOC) mailing, you may respond to inbound questions and discuss only the changes for the plan a member is currently enrolled in. If prior authorization or advance notification is needed for the requested elective inpatient procedure, it is the physician's responsibility to obtain the relevant approval. By continuing to use our site, you agree to our Privacy Policy and Terms of Use. 383 0 obj <>stream It may take up to 15 calendar days to receive a decision (14 calendar days for UnitedHealthcare Medicare Advantage plans). Informal Sales Events: Agent offers plan info upon request only while at a table, booth, kiosk, or RV. When enrolling a D-SNP beneficiary, be sure to verify plan enrollment eligibility and that the MSP program level is eligible for the requested plan. To find your local broker manager, go to Aetnas Producer World. Returns the string ID of the notification button the user clicked. M M . Members in all plans impacted by the 2022 PDP contract consolidation will be reissued an ID card. In addition, ONLY for formal sales presentations: Complete the Sales Event Form and submit each Monday before 9:00 AM for previous weeks events. Shortly before she started at Ritter, Roxanne earned a Bachelor of Arts degree in English with a professional writing concentration from Elizabethtown College. The enrollee must file the grievance either verbally or in writing no later than 60 . endstream endobj 698 0 obj <>stream All day long, theres a lot of noise pinging from various media channels. Read More, Want to host a Medicare educational event or a Medicare sales event? Steps to take when safeguarding and securing PHI and PII include: Wellcare offers a robust portfolio of products and plans across _____ states. Notification of each inpatient admission must be received within 24 hours after actual weekday admissions (or by 5 p.m. local time on the next business day if 24-hour notification would require notification on a weekend or federal holiday). But, if the beneficiary is entitled to another enrollment period, like a Special Election Period (SEP), or if they are in their initial eligibility period, continue to operate as normal. You must adhere to certain regulations for marketing your sales event. Wellcare offers a robust portfolio of products and plans across _____ states. Which of the following statements about completing telephonic enrollments is FALSE? We prioritize case review based on the specifics of the case, the completeness of the information received and Centers for Medicare & Medicaid Services (CMS) requirements or other state or federal requirements. Submit your seminar events directly to Agent Oversight's medicaresemi@aetna.com mailbox. What type of events need reported: Answer the following questions using the appropriate counting technique, which may be either arrangements with repetition, permutations, or combinations. (Applications must be received at Wellcare within 1 calendar day of this date.) Editors Note: This was originally published in August 2017. See what you can and cannot do at sales events below. Noting the correct enrollment period on enrollment applications helps in preventing delayed enrollment processing. Share sensitive information only on official, secure websites. Prior to the Medicare Annual Election Period (AEP), you may have questions surrounding what you can and cannot do to market plans before October 1, which is the start of the AEP marketing period. Inpatient Notification Applicable To: Medicare Policy Number: CPP - 101 Original Effective Date: Revised Date(s): N/A BACKGROUND The Health Plan is committed to ensuring its members receive high quality care in the most appropriate setting. Sales and Educational. required for the initial visit has been received and documented, as required in regulation at 42 CFR 484.60(b) and 42 CFR 409.43(d); (2) the initial visit within the 60day certification period must have been made and the individual admitted to home health care. Box 436000. Key areas you as a Sales Agent / Broker have control over and impact upon regarding Star (Quality) Ratings are, Wellcare has added ____ new counties to our footprint in 2022. You can always contact Medicare.gov, 1-800-MEDICARE, or your local State Health Insurance Program (SHIP) for help with plan choices.. All formal Sales events must be reported at least 21 days ahead of the event date. The Centers for Medicare & Medicaid Services (CMS) collects information from Medicare plans to track beneficiary enrollment in Medicare Advantage (MA) Plans, improve care, and for the payment of Medicare benefits. Agents and brokers must record all calls (inbound and outbound calls) in their entirety, including calls to inform or educate clients about the event, as well as any post-event discussions. Wellcare's 2022 product expansion represents an 8% increase from 2021. Filing A Dispute. Returns a Notification object representing the notification that was clicked to fire the event. 0 Useful member resources (e.g. If marketing all plans within a service area, use: Currently we represent [insert number of organizations] organizations which offer [insert number of plans] products in your area. If you fail to notify WellCare of admissions or observation stays, the claim may be denied. 712 0 obj <>stream Formulary, Summary of Benefits, Evidence of Coverage, etc.) WellCare needs this notification to obtain clinical information to perform case management and ensure coordination of services. Note that the online verification must indicate that the member is not covered by UnitedHealthcare. Agents may be investigated after being suspected of noncompliant activity reported throughSelect all that apply. For virtual events, use Aetna Medicare seminar reporting template, and in the address column provide the URL, call-in number and meeting codes for the event. When discussing prescription drug coverage, agents should: From October 1st to October 14th, what activity is not permissible by agents: Assist with completing and collecting completed applications. Below are registration details and directions for specific carriers.