CALL FLOW
We can't ask for the social security number from calls from which state?
California
What does HIPAA mean?
HEALTH INSURANCE PORTABILITY AND ACCOUNTABILITY ACT
Mention 3 rules about HIPAA
I. Privacy rule
II. Security tule
III. Breach notification rule
Name 3 of the essential medical care and wellness services
Emergency Care
Outpatient or Ambulatory Care
Preventive & Wellness Care
Maternity & Newborn Care
Pediatric Care
Mental Health & Substance Abuse Care
Laboratory Services
Prescription Drugs
Therapy Services
Hospitalization
what are the payment options?
Ecashering, mail, voicepay, online.
What is a Call flow?
A call flow is a road map to how calls will be handled from the moment they enter the phone system to the end of the call. Call flows can be used to handle even the most complex call scenarios and enable great customer care.
What are the three main rules for hipaa?
1. Privacy rule
2. Security rule
3. Breach notification rule
What PHI stands for?
Personal health information
what is the name of the materials use to call all the categories?
metals
What is the acronym for advanced premium tax credits?
APTC
Call flow(simulate a phone call)
Customer Juan Eduardo.
roll call - doctor change
Includes actions that may, directly or indirectly result in unnecessary cost
Abuse
A person who exposes information or activity that is deemed illegal, dishonest or violates profesional or clinical standards?
Whistlebower
How Many Services are included in a membership plan ?
10
Who needs to approve refunds over $500
supervisor
What are we supposed to ask the member before we disconect the call?
do you have any other questions or concerns?
What "prevents, detects and corrects non-compliance"?
Effective Compliance Program
Knowingly and willingfully executing (or atempting to) a scheme o artifice to defraud healtcare OR submutting false info to the government.
Fraud.
What is the range of date of the enrollment period?
15th February to December 1fst
Subscribers have the ability to self manage their payment account and view ____ using the ambetter secure online member portal
invoice / payment history
What state is NH
New Hampshire
Which part of Medicare covers the prescription drug benefit coverage Program?
Medicare Part D
Measures TP takes to protect it's costumers, clients & employees from potential risks.
Safeguards
Change in plan name
bronce - Essential
Silver -
Gold -
Silver - Balanced
Gold Secure
Whats the process of initial payment, when we talk about pay now?
Application submitted-payment made (status-enrolled) - monthly invoicing begins