Must include most of the required elements necessary to complete the enrollment, A passing score of __ or higher must be achieved to successfully complete this course. However, if you cancel the event at least two days in advance, its a good practice to notify potential attendees via the same advertising channels you used to promote the event. Youll need to follow CMS rules for hosting sales events. You can find support numbers and agent portal links all in one place on the Ritter Docs carrier pages! Behavioral health products provided by U.S. Behavioral Health Plan, California (USBHPC), or its affiliates. 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! 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. website belongs to an official government organization in the United States. To learn carriers reporting requirements, start by looking in your online agent portal for guidance. When creating ads or invites, you cannot require potential attendees to provide contact information to RSVP for the event. 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. 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. Rank the following in order of Wellcare's 2022 product expansion represents an 8% increase from 2021. lock 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. The agent of record will not remain with the member after the consolidation. Sales. Which of the following is not a Wellcare quality driver? If youre a licensed agent within an Aetna local market, submit your events directly to your market. Key areas you as a Sales Agent / Broker have control over and impact upon regarding Star (Quality) Ratings are: All Wellcare standalone PDP plans will have a $0 Tier 1 preferred retail and mail benefit. ( Verbal permission granted to discuss plan details qualifies an authorized representative to complete an application on behalf of the beneficiary. Wellcare has added ____ new counties to our footprint in 2022. 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. While just putting out a flyer with your sales seminar or workshops information on it seems nice, its unacceptable. This page was last modified on Apr 8, 2023 by MDN contributors. xy| W4Do""4 ( EOE[kUK--*HU- *bd_ncrsr#3g~s{3wllAAAAAAAAAAAAAAAAAAAAAyA>PTpTcw8Vt:xvZ UAcuwa;mCg@xAA Which of the following statements about completing telephonic enrollments is FALSE? Wellcare Flashcards | Quizlet Questions regarding theNOMNC and DENCcan be submitted at: https://appeals.lmi.org. Upon completion of the event, break down your table and chairs, and notify the Management Team Member that the event is over and that you are leaving Kindly thank them for having you there Don'ts Do not conduct health screenings or other like activities that could give the impression of "cherry picking" Which stage of coverage is referred to as the "donut hole" as the member is paying the most for drug coverage? / b5k0pYt)y ]P3 FbKx>]j Ay{{2( 2000 2023 SENIOR MARKET SALES. Submission Deadlines: Only Cigna employed agents are required to report educational events. While events are often a great way to generate leads, holding Medicare educational events during the COVID pandemic is a legal and ethical grey area. Please contact Medicare.gov or 1-800-MEDICARE to get information on all of your options. 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. Useful member resources (e.g. ET on EWTN: Holy Mass and Rosary on Saturday, April 22, 2023 Tell us where you're. Use online event reporting tool. If a drug is not covered or there are restrictions or limits on a drug, you may request a coverage determination. You can always contact Medicare.gov, 1-800-MEDICARE, or your local State Health Insurance Program (SHIP) for help with plan choices.. If your event involves marketing Medicare Advantage or Part D, then you must also include the following Third-Party Marketing Organization (TPMO) disclaimer on any printed materials distributed for the event. Which of the following statements about Scope of Appointment (SOA) is FALSE? PDF "No Pay RAP" Fact Sheet and Frequently Asked Questions - NAHC Copyright 2023 Wellcare Health Plans, Inc. Notice Regarding Inpatient Admission Authorization Requirements. a drug that requires prior approval. M M . Administrative services provided by OptumHealth Care Solutions, LLC, OptumRx, Oxford Health Plans LLC, United HealthCare Services, Inc., or other affiliates. Heres what sets them apart: After you do that, you should decide on the when and where. Wellcare ACT 2022 (Centene) Flashcards | Quizlet Join the thousands of independent agents getting the first word from Ritter. The facility must notify UnitedHealthcare within 24 hours (or the following business day if the admission occurs on a weekend or holiday) of the elective admission. ), Give away promotional items that include plan name, logo, toll-free number, and/or carrier website, Use contact information provided by attendees for raffles or drawings for any other purpose, Provide refreshments or light snacks (e.g., coffee, soda, fruit, crackers), Hand out objective educational materials on Medicare Advantage, Part D, and other Medicare programs, Offer or subsidize meals or a combination of foods and beverages that could make it seem like youre offering meals, Distribute Star Ratings information, Summary of Benefits, Pre-Enrollment Checklist, and the Multi-Language Insert with any enrollment form, Require attendees to fill out a Scope of Appointment form or enrollment forms, Collect lead cards and business reply cards, Use the necessary TPMO disclaimer on printed marketing materials, Freely give out your business card to any attendee, Arrange follow-up appointments & collect Scope of Appointment forms for future appointments, Call attendees who attended a sales event if they gave express permission at the event for a follow-up call (you must have documented permission to contact), Within 48 hours of its originally scheduled date and time for any reason (including zero attendance), At least 48 hours in advance of its originally scheduled date and time. Call our Member Services Department at 1-800-247-1447 (TTY users should call 1-800-695-8544), write to us . You can follow these guidelines to stay compliant: WELLCARE CENTENE Flashcards | Quizlet All informal marketing and educational events, report to SMSE at least 7 days in advance of the event date. The earlier you submit your events to carriers, the sooner youll be able to start advertising them. 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 promote your gathering online, via direct mailers and flyers, or through other forms of media. Reporting template and e-mail address: You can decide how often to receive updates. 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. Rights, Appeals, and Disputes - Fidelis Care Official websites use .govA 9 essential traits of a good husband. through innovation. Wellcare has streamlined standalone PDP offerings from six plans to ___ in all 34 regions across all 50 states and D.C. For the 2022 plan year, which health plans will be consolidated into the Wellcare Medicare brand: Health Net, Fidelis Care, AllWell, 'Ohana, Trillium Advantage, WellCare. A NotificationEvent. endstream endobj 335 0 obj <. Note: Any event not advertised as educational can be viewed as a marketing event and should be registered as one. Submission Deadlines: are available online at the health plan website. Enable JavaScript to view data. 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. 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. Upon certification, access to the Single Sign-On Portal, Agent Connect (Broker Portal) and Custom Point (Materials Ordering) broker resources is gained. Be sure to explain why this counting technique applies to the problem. Conducting a compliant Medicare sales event can seem intimidating, however, you shouldnt let that stop you from adding them to your list of strategies to grow your insurance business. The NOMNC informs beneficiaries on 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. Getting to know all your carriers reporting requirements is important. 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. To download the NOMNC and DENC,please click on the appropriate link below in "Downloads". Check the carrier's website/portal for the most current procedures. Share sensitive information only on official, secure websites. I understand that when my Wellcare coverage begins, I must get all of my medical and . 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. Wellcare's quality focus consists of six drivers. This policyshould be read in its entirety. 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). hbbd```b``V+@$>.J`>0)&e@$Kd RDrG(m AdH%c!;#]ADg` r Medicare Star Ratings and performance are at the forefront of Wellcare's quality strategy. Sometimes you may have to cancel your sales event. Study with Quizlet and memorize flashcards containing terms like When completing an application, you should ensure that you enter the provider ID of a specialist and not a Primary Care Physician (PCP)., Noting the correct enrollment period on enrollment applications helps in preventing delayed enrollment processing., Wellcare has streamlined standalone PDP offerings from six plans to a. two . Official websites use .govA To find your local broker manager, go to Aetnas Producer World. means youve safely connected to the .gov website. TRUE Full instructionsfor the Original Medicare, also known as Fee for Service (FFS), expedited determination process are available in Section 260, of Chapter 30 of the CMS Claims Processing Manual, available below in "Downloads". x[K1NnThmZ;]n/C2$Na^RD;";*=|O &)N`T ;Xngzt_k)"IQB~pfI^%69ZXwp+s-,#nN$S6yZO[O];KU\PsVA5cPRZu/;h\`8.vmg2.WTte07TxiMhqU/n%c7h Notice Regarding Inpatient Admission Authorization Requirements - WellCare Reporting template and e-mail address: endstream endobj startxref In contrast to TQM, this approach seeks radical change Noting the correct enrollment period on enrollment applications helps in preventing delayed enrollment processing. IMPORTANT: If you call in your appeal, you must follow up with a written, signed request. Enrollment applications must be received by Wellcare no later than ___ calendar day(s) following receipt from the beneficiary. Which standalone Prescription Drug Plan is best for "dual-eligible" members? Many marketing and lead-generating activities are allowed, but there are rules regarding the information you can collect. If you fail to notify WellCare of admissions or observation stays, the claim may be denied. Agents may be investigated after being suspected of noncompliant activity reported throughSelect all that apply. Sometimes, we do not meet your expectations, but we would like to try to resolve your issues. Submission Deadlines: Filing A Dispute. Wellcare offers a wide variety of Medicare products consolidated under a new Wellcare brand. Remember, were always here to help with any questions, so you have nothing to fear. This is a summary of the Prior Authorization and Notification Program and is not meant to be comprehensive. Reporting template and e-mail address: PDF OMB No. 0938-1378 Individual Enrollment Expires: 7/31/2023 Request Form If you have questions about this article or other compliance questions, please contact our compliance department, or ask your marketer. Furthermore, if you fail to register an event with a carrier, you could lose out on sales commission and have your contract revoked. increasing (from negative to positive) cross-price elasticity of demand with coffee. Read More. {' (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 Sales and educational. Read More, Want to host a Medicare educational event or a Medicare sales event? How many executive committees are possible? 694 0 obj <> endobj a drug that is not on our List of Drugs (Formulary). ServiceWorkerGlobalScope: notificationclick event - Web APIs | MDN The enrollee must file the grievance either verbally or in writing no later than 60 . See what you can and cannot do at sales events below. ) 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. Include agent name, NPN, agents phone number, date of event. While you may plan to educate attendees on Medicare programs during your presentation, you cannot say your sales event is educational because educational events fall under a different definition and set of requirements. All standalone PDP formularies have a ___-tier structure for 2022. Wellcare By Fidelis Care strives to provide high quality care and service to our Medicare Advantage and Dual Advantage members. 09-70-0588. . Rules for Hosting a Compliant Medicare Educational Event Content available under a Creative Commons license. Email completed form to Debi Burrell-Thiem Debi.Burrell-Thiem@mutualofomaha.com. 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. ) Include agent name, NPN, agents phone number, date of event. Coverage Determinations and Redeterminations - Sunshine Health The DENC explains the specific reasons for the end of covered services. Rules for Hosting a Compliant Medicare Sales Event %PDF-1.5 % This includes all admissions, including admissions to behavioral health facilities. Please refer to the UnitedHealthcare Administrative Guide for program details and required protocols. This policy, the Schedule of Benefits, the application as submitted to the Health Insurance Marketplace, and any amendments and riders attached shall constitute the entire policyunder which covered servicesand supplies are provided or paid for by us. Find the present worth of the cash receipts in the accompanying diagram if i=10%i=10 \%i=10% compounded annually with only four interest factors. Formulary, Summary of Benefits, Evidence of Coverage, etc.) If youre a licensed Part D agent NOT within an Aetna local market, submit your seminar events directly to Agent Oversights medicaresemi@aetna.com mailbox. Reporting template and e-mail address: They fit here as well. Attn: Appeals and Grievance Department. lock 334 0 obj <> endobj Appeals and Grievances .gov We do not offer every plan available in your area. Reporting template and e-mail address: Thank you for your continued participation and cooperation. All information provided on this website is for Agent Use Only and not intended for public distribution. California and Washington providers, hospitals and other acute inpatient facilities are subject to the admission notification requirements described in the UnitedHealthcare Administrative Guide.
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