HAP
Who is the director of Customer Service?
Venus Pope
What is the required greeting for HAP Customer Service Specialists?
What is "Thank you for calling HAP Customer Service Department, my name is ____, how can I make your day better?"
What intent and category should be used to document HEDIS gaps?
What is the GSR / other.
This tool is used daily to locate a DLP.
What is OneNote?
This is how a CSS signs into CareRadius?
What is the network username without hap.org and the network password?
CS must always do this before capturing financial information.
What is pause the recording in Genesys.
Individual Medicare members must request dental coverage within this amount of time from his/her effective date of coverage.
What is 30 days from effective date of coverage.
Anytime during AEP for a 1/1 effective date.
Anytime during OEP for the 1st of the next month.
Which two cities does HAP have a lobby in?
What is Troy and Detroit
What is required for CS to close a call?
What is to ask the caller if there are any other questions or benefit questions.
How would a call be documented if the caller cannot be found in Pega?
What is Unaffiliated Caller?
This is where a CSS goes to locate an EOC or commercial source documents when not reflected in Pega.
What is Corporate Applications?
This is required once a CSS is finished looking at a member in CareRadius.
What is x out of tab that contains member name in the web browser.
This number must be copied from Pega and used to locate the member on the payment portal.
What is the AR account ID
This plan provides a monthly OTC benefit.
What are the SNP plans, DSNP and CSNP.
These two departments are the operational call centers for HAP.
What is Member Services and Provider Inquiry?
This company handles authorizations for high tech radiology.
Who is EviCore ?
This intent is used when a member wants to change their cell number for text messaging.
What is Update Member Profile?
This tool should be used to check if a procedure code requires a prior authorization.
What is the Procedure Reference List (PRL)?
To properly close out of an authorization, grievance or appeal in CareRadius, the CSS must do this.
What is selecting close in the grey bar to unlock the account for others?
This DLP would be used for assistance with handling a premium payment.
What is DLP.CS.056 Payment Processing?
This product always requires a PCP to direct their care.
What is HMO?
HAP partners with this company to provide dental coverage.
Who is Delta Dental?
These individuals are the managers of Customer Service.
Who is Kristen Pore' and Elaina Ferguson?
When a caller is part of an employer group and supposed to already be active, however is not showing up in Pega, CSS should do this.
What is document an Unaffiliated Caller intent and launch a GSR to route to M&B?
This tool should be used to determine if there is certain criteria required to be met for a specific service?
What is the Benefit Administration Manual?
CSS must do this to ensure he/she can see all authorizations, appeals and grievances for a member.
What is remove the filter date and select apply filter?
These members will not have any premium information in Pega.
What are employer group members?
Government handle commercial calls from this employer group.
Who is FEHB and PSHB?
This entity is the parent company of HAP.
What is Henry Ford Health System.
As a CSS, its always important to do this when away from his/her desk and unable to take a call.
What is change to the correct status in Genesys?
This intent and service item types is launched to document information provided to a caller about a specialist.
What is the General Service request / Access / Specialty care?
This tool is used to check for missing preventative services for a member.
What is HEDIS gap search?
This vendor handles authorization requests for musculoskeletal and cardiac procedures.
Who is Turning Point?
Members can pay their premium one of these four ways.
What is by mail, in the lobby, over the phone or online.
For this plan type, Medicare pays primary, HAP pays secondary, and the plan is treated as a commercial plan.
What is Medicare Supplemental (Medigap)?
This individual is the Vice President of Consumer Operations?
Who is Heather Spencer?
This department handles eligibility concerns among many other things.
Who is Membership and Billing?
This intent is launched when a member calls to determine his/her accumulations from a previous year.
What is Member Eligibility and Benefits intent?
This tool may be used if the member wants an estimate about their costs.
What is the Cost Estimator Tool
This service always requires an authorization.
What is inpatient care?
Invoices are generated this day of every month.
What is the 5th.
This is the only product that allows Flex card money to be spent on home modifications.
What are the Special Needs Plans (DSNP/CSNP)?
HAP has two initiatives that would like addressed on calls, what are they?
What are Communication Preferences and HEDIS gaps.
This is the Compliance Hotline phone number for members to call.
What is 877-746-2501
The caller needs to change PCP, has a question about a Specialist, has HEDIS gaps, needs communication preferences updated and needs benefits for OT. The CSS must document the following intents.
What is GSR / Access / Specialty?
What is GSR /Other?
What is Update Member Profile?
What is Update/Add/Chane PCP?
What is Member Eligibility and Benefits?
This resource is used when a member needs her password reset.
What is the Security Admin tool?
CS launches a Eligibility and Benefit intent and routes it to the Referral Management team (RMT) for this reason.
What is to initiate a member authorization request?
If the day is the 25th of the month and a caller wants to set up AWD, CSS should...........
What is take that months premium over the phone and set up AWD for the next months premium?
This employer group must contact RMBT if they have questions or concerns about their enrollment.
What are the UAW plans (Ford, GM, Chrysler)?