Provider
What systems do you use to search for a list of providers?
C & S Provider search and We Rally
When member has other insurance, what is the order of payment?
Medicaid is always the payer of last resort
Where will you find other agents notations?
General tab
What is UHC Mission statement
“ We strive to help people live healthier lives”
How long can you place the member on hold?
As much time that is needed, but no longer than 5 minutes
How long can you wait for provider to response, when you call their office?
2 minutes
When do you offer the member to schedule an appointment?
Whenever you are changing the PCP, or searching for a provider.
Besides COB where will you be able to see if the member has another insurance?
Other Carrier
Which Value is: We will walk in the shoes of people we serve and those with whom we work. We will actively listen to fully understand and genuinely empathize with people's realities.
Compassion
Before placing the member on hold what must you do?
Ask the member for permission.
When changing a PCP, when will the new PCP change take effect?
Immediately, on the day of the call
What is Macess used for?
In facets how will you be able to see what benefits apply to the member?
In Benefit Summery
Which Value: We will be accountable and responsible for consistently delivering high quality and superior results that make a difference.
Performance
How long do you have to answer an incoming call?
5 seconds if you hear the whisper tone and 10 seconds if you don't.
When searching for a provider, what SOP will you use?
CSP Provider look up
What is your go to tool for help on any subject?
Knowledge Central
What is the main purpose of facets?
To access, review eligibility and benefits, as well as notate the member's account.
Which Value is: We will honor commitments. We will never compromise ethics. We will speak the truth. We will deliver on our promises. We will have the courage to acknowledge mistakes and do whatever is needed to address them.
Integrity
Before ending the call what are the 2 questions you need to ask your member?
1. I able to resolve your issues for today?
2. Is there anything else I can assist you with?
When updating a PCP, What tab will you use to notate, and what subject and category will you use?
PCP- Tab, Subject: PCP Inquiry, Category: PCP - Update/ID card
When it comes to eligibility what is your source of truth?
The LA State Portal
How will you search for Authorized Reps in Facets?
Transfer, sub family, open customer, select member, and select responsible person.
Which Value is : We will learn from experiences of the past and use those insights to invent a better future to make the health care environment work and serve everyone more fairly, productively and consistently
Innovation
When will the only time you pitch the survey?
When the call is in another language besides English.