ConnectiCare
Member premium invoices are triggered or generated on this date
What is “the 5th of the month?”
This is a request for a reviewof a denied healthcareservice or payment
What is an appeal?
This HEART step meanslistening carefully to themember’s concerns
What is “hear?”
How long does it typically take for a deceased member update to beprocessed after being reported to Social Security?
What is 30-45 days
What is the name of thearticle used for questions onthe ConnectiCareAcquisition?
What is "ConnectiCare Acquisition Call Handling" article
Member premium payments are due on this day
What is “the end of the month?”
This type of complaintconcerns service issuesrather than coveragedecisions
What are grievances?
In this HEART step, youshould clarify the problemand decide the best nextstep
What is “assess?”
A beneficiary enrolled in a Medicare Advantage plan on January 1st qualifiesfor what election period?
The Medicare Advantage Open Enrollment Period.
What is the process for transferring a call internally?
What is Salesforce Phone Gadget Call Management with Genesys
This system allows you to view a member’s premium information
What is M360?
A member needs medicationurgently and cannot waitfor a standard review
What is an expedited appeal?
In this stage, agents providetimely solutions and makesure the member feelsconfident and satisfiedbefore ending the call
What is “resolve?”
True or False: A member can cancel enrollment at any time after the OEV letter is sent.
False
What KA would you use to decide when to use Hold vs. Mute
What is: Hold is used to reach out to another dept vs Mute is used for researching – Article: Hold vs. Mute Procedures
Members can use thisresource to sign up forautopay
What is the “Premium Payment Form?”
Failure to complete this step can delay the A&G department’s ability to resolve a grievance. What is it?
What is failing to obtain all necessary information (or documentation)?
These two steps in the HEARTapproach help build trust byconnecting emotionally withthe member and leaving themfeeling valued and appreciated
What are “empathize” and “thank?”
Name one reason a member may be involuntarily disenrolled
What is Loss of Medicaid, non-payment of premiums, or moving out of the service area
What article would you use to find "the why" we would xfer a caller to CM
What is Reasons to Transfer Call to CM Medicare
CCI members can pay theirplan premiums using thesepayment methods
What are:
Mailed Check
Electronic Funds Transfer (EFT)or eChecks (ACH)
Social Security Withold (SSA)
This CMS oversight system requires Medicare Advantage and Part D plans to log, categorize, and resolve certain complaints within strict timeframes, and repeated issues identified through it can directly impact Star Ratings and trigger compliance actions.
What is the Complaints Tracking Module (CTM)?
Clarifying uncertaintiesbefore offering a solution isan important part of the“assess” step because ithelps to avoid doing this
What is “giving misinformation or wrong information?”
The guided flow is an optional tool designed to assist agents with thedisenrollment and cancellation process.
False
Which article outlines agent expectations for handling calls and achieving First Call Resolution (FCR)
What is Call Handling Expectations