Here's what sets them apart: Formal Sales Events: Agent presents plan-specific information to an audience invited to the occasion. %%EOF 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" Furthermore, if you fail to register an event with a carrier, you could lose out on sales commission and have your contract revoked. endstream endobj startxref 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. (Applications must be received at Wellcare within 1 calendar day of this date.) Health plan coverage provided by UnitedHealthcare of Arizona, Inc., UHC of California DBA UnitedHealthcare of California, UnitedHealthcare Benefits Plan of California, UnitedHealthcare of Colorado, Inc., UnitedHealthcare of the Mid-Atlantic, Inc., MAMSI Life and Health Insurance Company, UnitedHealthcare of New York, Inc., UnitedHealthcare Insurance Company of New York, UnitedHealthcare of Oklahoma, Inc., UnitedHealthcare of Oregon, Inc., UnitedHealthcare of Pennsylvania, Inc., UnitedHealthcare of Texas, Inc., UnitedHealthcare Benefits of Texas, Inc., UnitedHealthcare of Utah, Inc., UnitedHealthcare of Washington, Inc., Optimum Choice, Inc., Oxford Health Insurance, Inc., Oxford Health Plans (NJ), Inc., Oxford Health Plans (CT), Inc., All Savers Insurance Company, or other affiliates. 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. When completing an application, you should ensure that you enter the provider ID of a specialist and not a Primary Care Physician (PCP). Agents may be investigated after being suspected of noncompliant activity reported throughSelect all that apply. Acute care hospitals, skilled nursing facilities and acute rehabilitation facilities are responsible for admission notification for inpatient services, even if the coverage approval is on file. This event is not cancelable and does not bubble. 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. ) 0 Official websites use .govA All information provided on this website is for Agent Use Only and not intended for public distribution. Shortly before she started at Ritter, Roxanne earned a Bachelor of Arts degree in English with a professional writing concentration from Elizabethtown College. 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. Steps to getting contracted plus plan information, Phone numbers and links for connecting with us, List of contracted, high-quality independent lab providers, Update, verify and attest to your practice's demographic data, Provider search for doctors, clinics and facilities, plus dental and behavioral health, Policies for most plan types, plus protocols, guidelines and credentialing information, Specifically for Commercial and Medicare Advantage (MA) products, Pharmacy resources, tools, and references, Updates and getting started with our range of tools and programs, Reports and programs for operational efficiency and member support, Resources and support to prepare for and deliver care by telehealth, Tools, references and guides for supporting your practice, Log in for our suite of tools to assist you in caring for your patients. PDF OMB No. 0938-1378 Individual Enrollment Expires: 7/31/2023 Request Form All informal marketing and educational events, report to SMSE at least 7 days in advance of the event date. 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. If youre a licensed agent within an Aetna local market, submit your events directly to your market. 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. %PDF-1.5 % If marketing fewer than all plans within a service area, use: We do not offer every plan available in your area. hb```f`` P ,@Q LN.``5 Li|SRRQlURx~hhEGG0d``3Y@$q`\(Meg*#r,lb ;4*Z10Xe=b|!&S@0W{ @J)G Z3 notification of events must be received by wellcare Agents do not need to record conversations when meeting in person. Identify the INCORRECT statement regarding the plan consolidation. 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. If the event is submitted to Cigna after the 15th of the prior month, the event is logged in the Sales Event Master Log at least 10 calendar days prior to the event. PDF Policy and Procedure Which stage of coverage is referred to as the "donut hole" as the member is paying the most for drug coverage? Submission Deadlines: 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. Administrative services provided by OptumHealth Care Solutions, LLC, OptumRx, Oxford Health Plans LLC, United HealthCare Services, Inc., or other affiliates. 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. Getting to know all your carriers reporting requirements is important. While just putting out a flyer with your sales seminar or workshops information on it seems nice, its unacceptable. Filing A Dispute. 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. ) Editors Note: This was originally published in August 2017. Currently we represent [insert number of organizations] organizations which offer [insert number of plans] products in your area. Which of the following statements about completing telephonic enrollments is FALSE? It has been updated to include information more relevant to the 2023 Annual Enrollment Period. In addition, ONLY for formal sales presentations: Complete the Sales Event Form and submit each Monday before 9:00 AM for previous weeks events. The earlier you submit your events to carriers, the sooner youll be able to start advertising them. Please refer to the UnitedHealthcare Administrative Guide for program details and required protocols. 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. Appeals and Grievances Coverage Determinations and Redeterminations for Drugs. What type of events need reported: 17K views, 519 likes, 455 loves, 3.7K comments, 232 shares, Facebook Watch Videos from EWTN: Starting at 8 a.m. %PDF-1.5 % Wellcare offers a robust portfolio of products and plans across _____ states. 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. hbbd```b``V+@$>.J`>0)&e@$Kd RDrG(m AdH%c!;#]ADg` r Returns a Notification object representing the notification that was clicked to fire the event. 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. 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? You can ask us to . lock Submit your seminar events directly to Agent Oversight's medicaresemi@aetna.com mailbox. 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. This includes all admissions, including admissions to behavioral health facilities. 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. 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 ServiceWorkerGlobalScope: notificationclick event - Web APIs | MDN 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. Wellcare offers a wide variety of Medicare products consolidated under a new Wellcare brand. Official websites use .govA Submit marketing/sales event information to your Cigna manager/broker sales representative (BSR). A coverage determination 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. To learn carriers reporting requirements, start by looking in your online agent portal for guidance. ( 7500 Security Boulevard, Baltimore, MD 21244, An official website of the United States government, Parts C & D Enrollee Grievances, Organization/Coverage Determinations, and Appeals Guidance in the , Medicare Managed Care Appeals & Grievances, Reconsideration by the Medicare Advantage (Part C) Health Plan, Review by Part C Independent Review Entity (IRE), Beneficiary Family Centered Care-Quality Improvement Organization (BFCC-QIO) Review, Hearing by an Administrative Law Judge (ALJ), Parts C & D Enrollee Grievances, Organization/Coverage Determinations, and Appeals Guidance (PDF), Problems getting an appointment, or having to wait a long time for an appointment, Disrespectful or rude behavior by doctors, nurses or other plan clinic or hospital staff. My Blog notification of events must be received by wellcare 2022 Selling with Integrity- Telesales- Cigna. 334 0 obj <> endobj Coverage Determinations and Redeterminations The Part D Senior Savings Model (SSM), which reduces member spending on insulin, will be offered on the Value Script and Value Plus products. You can decide how often to receive updates. Reporting template and e-mail address: 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. You must adhere to certain regulations for marketing your sales event. There are two types of sales events: formal and informal. https:// Reporting often involves submitting an event information form to a sales manager or representative through email or using an online reporting tool. 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. Sales Event Log Templates and the Sales Event Form are available from the Cigna manager/BSR. Submit the Sales Event Log Template prior to the 15th of the month for the following month's events. Content available under a Creative Commons license. 694 0 obj <> endobj 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. Not everything goes as planned. By treating all attendees with respect and following the rules, you can ensure a secret shopper will only have good things to report. 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.. The agent of record will not remain with the member after the consolidation. Secure .gov websites use HTTPSA 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. 703 0 obj <>/Filter/FlateDecode/ID[<67F0BD7F13C0954A86E91F0B2348D473><5B2166B97063C944BC73801949E4E4FA>]/Index[694 19]/Info 693 0 R/Length 68/Prev 440259/Root 695 0 R/Size 713/Type/XRef/W[1 3 1]>>stream
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