2013 HISC Medicare Products Training and Certification Guide

Transcription

1 2013 HISC Medicare Products Training and Certification Guide 1

2 Purpose The purpose of this guide is to assist agents in preparation for the 2013 HISC Medicare Products Training and Certification requirements This guide will provide the following: 2013 certification deadlines Accessing Training High-level overview of each course Helpful Hints 2

3 Certification Deadlines 3

4 Certification Deadlines Failure to certify/complete the 2013 HISC Products Training & Certification requirements by December 14, 2012 will result in the following: 1. Cannot market, sell, or service 2013 BlueMedicareRx plans. The BlueMedicareRx book of business (effective dates ) will be moved to the HISC house account. 2. Loss of all BlueMedicareRx renewal compensation for calendar years and all remaining years on the compensation cycle 3. Unable to regain Book of Business if certification occurs after December 14, 2012 deadline June 24 th 2012 AHIP Course Closed for producers Early September: 2013 certification opens for producers December 11 th 2013 certification closes for Sub Agent January 2: 2013 certification reopens for Feb 2013 effective dates and beyond June 25 th 2013 AHIP Course Opened for producers December 14: 2013 certification closes for all individual producers and agency principle (renewal compensation deadline) 4

5 Accessing Training 5

6 Accessing Training 1. Go to Blue Access for Producers (BAP) or your announcement (Blue Notes) 2. Click the 2013 HISC Medicare Products & Training link 6

7 3. You will be directed to the Knowledgewire site to login User ID/Password i. Producer/Agent: Use your 9-digit HCSC assigned Producer ID# Producer ID#: ii. iii Agency: Use your 9 digit HCSC assigned Agency ID# Use Agency ID#: Password: If you certified last year use your same password from last year. If you are a new producer for 2013 Your password is: 9 digit HCSC Producer # New password: If you have trouble logging in see page 8. How to access forgotten password 7

8 Click the Forgot Password Enter address Password will be sent to user 8

9 Software Support Information You will need one of the following software applications to access the 2013 Medicare Products & Training and Certification i. Windows2000 ii. WinXP iii. Windows 7 iv. Internet Explorer: versions 6, 7 & 8 v. Adobe Acrobat Reader v. 6.x vi. Adobe Shock Wave: versions 10.3+, 11 vii. Adobe Flash: versions 7 11.xIf Helpful Hint: If you have questions concerning software compatibility or if you do not have one of the following applications please contact the HCSC ITG Help Desk at for assistance. 9

10 2013 Sales Agent Requirements Overview 10

11 1. CMS requirements Sales Agent Requirements Overview Approximate Course Length: 15 minutes 2. Specific audience requirements 3. Deadlines Agency Principal Subagent Independent Agent Deadline to sell during the 2013 enrollment season Renewal Payment Deadline 4. Agency/Sales Agent Communications options Agency amendment execution Completion Incomplete Business removal Exam failure letter 5. Referral Program (MAPD & PDP) 11

12 2013 Medicare Basics Course Overview 12

13 Medicare Basics Course Overview Approximate Course Length: 40 minutes 1. Medicare Parts and Eligibility 4 main parts of Medicare and eligibility for all 2. Identify Medicare coverage options Original Medicare Original Medicare + Medicare Supplement Original Medicare + Medicare Supplement + PDP Original Medicare + PDP Medicare Advantage Plan with PDP (MAPD) Medicare Advantage Plan i. HMOs, PPOs, PFFS, SNPs, MSA, PACE, and Medicare 1876 Cost Plans 3. Identify the coverage phases of Medicare Part D plans and the 2013 limits Part D deductible Initial Coverage Limit TrOOP Costs Coverage Gap i. Generic Discount in Coverage Gap ii. Brand Discount in Coverage Gap Catastrophic Coverage 4. Identify the rights of Medicare beneficiaries General Rights Fraud & Identity Theft Protection Billing Fraud Protection Reporting Fraud 13

14 2013 Medicare Marketing Rules & Regulations Overview 14

15 Medicare Marketing Rules & Regulations Overview Approximate Course Length: 60 minutes 1. General CMS guidelines for a marketing/selling a Medicare Product Approved service area Accurate information Approved materials Audit requirements Telephone contact Testimonials Face-to-Face and/or event marketing Incentives 2. Difference in Educational events and Marketing events Promoting events Reporting requirements Acceptable/Unacceptable practices 3. Identify CMS guidelines for face-to-face marketing activities Face-to-face marketing activities Scope of Appointment requirements i. Walk-ins ii. Sales events iii. Limited exceptions iv. Audit requirements v. Face-to-face vi. Expanding the product scope 4. What is an education event? Education event locations Promoting education events Acceptable and Unacceptable Practices 5. What is a marketing/sales event? Informal vs. Formal Marketing/sales event locations Marketing/sales event promotion Acceptable and Unacceptable Practices Cross-selling 6. What are CMS requirements for gifts and prizes? Nominal gifts and prizes Gift/prize disclaimers 15

16 7. Identify the three types of enrollment periods Initial Enrollment Period (IEP) Annual Enrollment Period (AEP) Special Enrollment Period (SEP) 8. Understand Enrollment/Disenrollment procedures/process Late Enrollment Period (LEP) Creditable Coverage Medicare Advantage Disenrollment Period (MADP) Voluntary/Involuntary disenrollment 9. Understand the Annual Notice of Change (ANOC) 16

17 2013 Product Course Overview 17

18 Product Course Overview Approximate Course Length: 80 minutes 1. Product Offerings through Blue MedicareRx Employer Individual i. Value Plan ii. Plus Plan 2013 changes 2. Understanding the BlueMedicareRx Formulary Formulary Tiers How to find a drug on the formulary 2013 Formulary Changes 3. Blue MedicareRx Pharmacy Network Preferred Network Pharmacy Mail-order Non-preferred Network Pharmacy i. Out-of-network Pharmacy Locating a BlueMedicareRx Pharmacy 4. Marketing BlueMedicareRx Setting up a Marketing Appointment Scheduling a marketing and/or sales event Using and Ordering 2012 BlueMedicareRx Collateral i. Forms ii. Event Marketing iii. Sales and Enrollment iv. Spanish Material v. Ordering Collateral 5. Methods for Enrolling in BlueMedicareRx Identifying eligibility Providing enrollment options i. Mail ii. Online iii. Fax Billing Options i. Electronic Funds Transfer (EFT) ii. Paper Billing Statement iii. Social Security Administration (SSA) Deduction Request for Information (RFI) Process 6. Servicing BlueMedicareRx 18

19 Switching Plan Designs Switching Billing Options Billing Delinquency Process Formulary Exception Process Transition Process Grievance Process i. Filing a grievance ii. Responding to the grievance Expedited Grievances Filing a grievance with a Quality Improvement Organization Appeals Process 7. BMRx Monitoring and Oversight Marketing and Sales i. Confirming Certification Status ii. Requesting Scope of Appointment Forms iii. Using Secret Shoppers iv. Researching Complaints v. Sales and Marketing Events Enrollment i. Verifying web enrollments have supporting paper enrollment form ii. Confirming Certification Status iii. Monitoring Late Applications Compensation i. Confirming Certification Status ii. Rapid Disenrollment Corrective Action Measures Monitoring and Plan Ratings 8. Resources available for sales agents Help Desk Blue Access for Producers (BAP) Resource Guide Blue Notes 19

20 2013 Contractual Requirements and FWA Overview 20

21 Contractual Requirements and FWA Overview Approximate Course Length: 30 minutes 1. Understanding the Medicare Plan Amendment Responsibilities (HISC and Agents/Producers) Laws and regulations Automatic updates Code of conduct Compliance Program i. Compliance with Medicare marketing requirements ii. Compliance with Grievance and Appeals iii. Privacy, Security, and Confidentiality Compensation Agent/Producer s representations and covenants Producer s subcontractors/sub producers Record retention Exclusion list Monitoring and corrective action Notification of alleged failures 2. Contractual requirements and fraud, waste, and abuse for MAPD and PDP 3. Identify primary fraud, waste, and abuse laws and regulations Identify Fraud, Waste, and Abuse Who commits Fraud, Waste, and Abuse Fraud, Waste, and Abuse Laws and Regulations i. Affordable Care Act (ACA) ii. Anti-Kickback Statute iii. Federal False Claims Act iv. Health Insurance Portability and Accountability Act (HIPAA) v. Health Information Technology for Economic and Clinical Health (HITECH) 4. Reporting fraud, waste and abuse 21

22 Helpful Hints Navigating through the Course Click all highlighted buttons Scroll completely through all highlighted sections Notes: Certify Early to make sure you can start selling BMRx at the beginning of the initial enrollment period If you re a sub agent, give your principal time to complete their requirements. Sub agents are not deemed certified until the agency principal completes the agency certification requirements Keep copies of all communications 22

23 Helpful Hints Make sure you take all courses and exams required. Once you are logged in you will see a page with all exams assigned to you After each exam, you will need to go back to the To Do List page to complete the next exam. View your completed exams Task name (i.e., course, exam or form) Go here to history to view completed course content 23

24 Requirements Producer: 12 tasks Annual Information Form Sales Agent Requirements Course Medicare Basics Course Medicare Basics Exam Medicare Marketing Rules & Regulations Course Medicare Marketing Rules & Regulations Exam PDP Product Course PDP Product Exam Contractual Requirements & FWA Course Contractual Requirements & FWA Exam Producer Certification Form Producer Amendment Subagent: 11 tasks Annual Information Form Sales Agent Requirements Course Medicare Basics Course Medicare Basics Exam Medicare Marketing Rules & Regulations Course Medicare Marketing Rules & Regulations Exam PDP Product Course PDP Product Exam Contractual Requirements & FWA Course Contractual Requirements & FWA Exam Producer Certification Form Agency: 12 tasks Annual Information Form Sales Agent Requirements Course Medicare Basics Course Medicare Basics Exam Medicare Marketing Rules & Regulations Course Medicare Marketing Rules & Regulations Exam PDP Product Course PDP Product Exam Contractual Requirements & FWA Course Contractual Requirements & FWA Exam Agency Certification Form Agency Amendment 24

25 Subagent-Agency Principal: 4 tasks Annual Information Form Sales Agent Requirements Course Agency Certification Form Agency Amendment 25

26 Exam Attempts Three attempts per exam I. Passing score is 85% II. III. IV. All questions must be answered in order for the exam to be submitted If a user stops in the middle of an exam and exits the program or is locked out due to inactivity (20 minutes), the exam will not count as long as the SUBMIT button was not selected. Unlike the courses, the exam will start from the beginning. Exam attempts only occur after SUBMIT button has been selected V. Do NOT open windows or browsers while taking the exam. Once window is open, it may count as another attempt to take the exam 26

27 Check List: Review the guide Confirm how you want to login: Producer versus Agency Verify you have the correct 9 digit HCSC assigned ID number Verify you have the required software o For assistance: o HCSC ITG Help Desk o Confirm if you are a principal and that HCSC has the most updated principal information on file. If you are a sub-agent, complete the exam early to allow time for your agency principal to complete the agency requirements. Take notes during courses Make sure you take all the exams required 27

28 Contact Information 1) ITG Helpdesk: (all four states) Assist with technical questions regarding logging into Knowledgewire Assist with log-in and password issues Assist with software needs: Windows2000 WinXP Windows 7 Internet Explorer: versions 6, 7 & 8 Adobe Acrobat Reader v. 6.x Shockwave 10.3+, 11 Flash 7, 8, 9 2) BMRx Certification mailbox: bmrxcertification@hcsc.net Certification questions related to: AHIP Agency Amendment Credit Curriculum Assignments Log in and password issues CE Credits 3) Producer Service Center: (all four states) Commissions (Status, Amounts, Split %, Payment Schedules etc...) Producer contracts Producer appointments Licensing Other inquiries if applicable 4) Part D Help Desk Enrollment Status Membership Rates and Billing Benefit Design and Interpretation Claims Status Blue MedicareRx(PDP) is a stand-alone prescription drug plan with a Medicare contract offered by HCSC Insurance Services Company, an Independent Licensee of the Blue Cross and Blue Shield Association under contract S5715 with the Centers for Medicare and Medicaid Services. A stand-alone prescription drug plan with a Medicare contract. 28