Identifying Medicare D Phases

Question 1

To identify the phase on an EGWP claim, you must be on _____

Answer 1

The Medicare D claim.

Question 2

True or False : Medicare phases are always labeled the same, but may be in a different order, depending on the plan type.

Answer 2

False - Medicare phases may be represented by different labels, but will always go in the same order no matter the plan or method of research used.

Question 3

Deductible is abbreviated as _____

Answer 3

DED

Question 4

Catastrophic is abbreviated as _____

Answer 4

OG (for “Over Gap”)

Question 5

IG stands for _________

Answer 5

“In Gap”

Question 6

When reviewing phases numerically, 03 is used to represent which phase?

Answer 6

Gap Phase

Question 7

When reviewing phases numerically 02 is used to represent which phase?

Answer 7

Initial Coverage

Question 8

If you need to identify what phase a member is currently in, where might you look?

Answer 8

The SDC Info screen, which is located on the second tab of the Member Screen.

Question 9

If you wanted to identify what phase a member was in on a specific claim, where can you find that information?

Answer 9

1. On the Transaction Lookup screen, going to the Claim Response tab, and scrolling to the very bottom of the Med D Claim.
2. In Paid Claim Lookup, on the Handler Info tab, reviewing which columns have dollars.

Question 10

True or False - There are only 3 ways to identify the phase.

Answer 10

False. There are many ways, but we train only the three simplest methods.