Oh System, My System!
Where do you navigate to find who is listed as RP or Custodial Parent?
Under Eligibility --> Enrollee
What should DMA(s) advise CSR(s) to do for Provider Billing Errors
Reach out to SST
Where can we find Tips of The Day (TOTD) in the PRG?
Under the Did You Know Section
If a claim needs to be reprocessed we send it here
Dental Reimbursement
-> TX Employee
Member has additional medical issues that can cause them to have concerns in dental office
DCM
How do you upload documents to a Member's profile?
Before Closing the Call -->
Save all Documentation as a PDF -->
Attach Document to the Attach Tab -->
Also upload to Documents under Eligibility Tab
What should DMA(s) advise CSR(s) to do when they state that Caller is not in RP Tab and wanting to change Provider assignment?
Check Under the Custodial Tab, if in office Fill out MDH Change form, or Register/Login to Website and change assignment online
Where can the Eligibility form be found in the PRG?
Under Documentation
Forms and Documentations: OK to send out
When a question in chat is out of our scope, we refer them to which Department?
SST
If you receive an email from David from The Boys and Girls Club, asking about availability for a presentation
CBCs
Where do DMAs navigate to submit a Same Day Complaint?
System Navigation -->
Customer Service -->
Appeal, Complaints, and Grievances Module -->
Complaint Management
What should DMA(s) advise CSR(s) to do when CSM is not allowing PCP Change?
Complete Template and send email to DMAs or advise office to complete MDH Change Form
Where can Agents find Routing instructions for Follow ups in the PRG?
Submitting Follow Ups - CSR Workflow
If a provider calls in with an issue about their contract
Provider Advocates
Member has a tailor made Health Plan, that takes them through their Health Journey
DCM
Where do you navigate to Update a member's address ?
System Navigation -->
Members -->
Enrollment Module
What should DMA(s) advise CSR(s) to do when asking if there is a Process to Exceed the CHIP Maximum?
Advise to review TX CHIP Max Exceed Talking Points in PRG.
Where can Agents locate the ER FAP Guidelines in the PRG?
Under FAP Guidelines
Member calls in with an eligibility issue
Member Advocates
Member needs additional resources that are outside of DMA scope
DCM and CBCs
How do you log a Same Day Complaint Creation in your Call Qualification for the Member?
You select Inquiry Type as Same Day Complaint and use the Complaint Code as Your Inquiry Category
Making sure to enter the Complaint Number to your Notes
What should DMA(s) advise CSR(s) to do when asking about COB and Caller states they have already called 2-1-1 prior to the 15th of the last month?
Please send a follow up to the UHC Texas Member Advocates
Where can Agents find the Same Day Complaint SOP in the PRG?
Under CSR Job Aids
Authorization Denied stating "No X-rays", but X-rays attached via NEA #
Authorization Department
If a member wants to compare plans across companies, who do they go to?
CBC