HIPPA
what should you ask the member once you obtain the member name and id number?
confirm if they are the member or their relationship to the member
after you complete the 4 pieces of Hippa what is the next step in the call flow?
confirm if besides horizon nj health and Medicaid does member have any other insurance?
Define Formulary
which tab in facets will we be able to see who the personal rep for the member is?
Address Tab
what is the purpose of the Provider Directory tool?
Search for any medical provider member is looking for
define WARM and COLD transfer
warm-We wait on the line to speak to a live rep before transferring
Cold-we do not need to stay on the line we automatically dial and transfer out
member with plan NJ Family Care A, ABD, D will you assist?
Yes
define WARM and COLD transfer
warm-We wait on the line to speak to a live rep before transferring
Cold-we do not need to stay on the line we automatically dial and transfer out
What should you do if a member does not respond once you say your opening?
say your opening twice and then disconnect the call after advising due to no response then can call us back for further assistance
Which tab will provide us the Medicaid number and a list of all the calls the member has made to horizon?
General Tab
behavioral/substance/Mental benefits are covered by who?
NJ Family Care- this is a FFS
define authorization
Authorization is approval by the health insurance for specific services to be rendered to the member.
what information is found in the COB tab
Other health insurances the member might have
Name the tool that you will use for help looking up answers to your callers questions
Horizon Knowledge/Pega
what is the definition of FFS/Fee for service
Services billed to and paid by Medicaid