HIPAA
Third party caller without verbal consent may receive any specific information regarding the member's plan at any time? True or false?
False
What STC should be used when members calls requesting to switch to a new PCP?
C0329
What is a Grievance?
When a member expresses dissatifaction about something other than the way the claims, medical or pharmacy approval decision is processed
We can disclose the member ID to the caller since we were able to authenticate the caller's information, and the member was so nice to you and you had a great conversation? True or false?
False
If a member request a Retro PCP Change it can be made retroactively during what days with out Operations approval ?
The initial 5 days of the month
What service center should we use to file a Standard grievance?
Customer Contact Center
Verbal consent is used whenever the member wishes to authorize someone to act as their representative during the call to receive any information, process a change, submit a grievance , file an appeal and ort make coverage request on the member's behalf, if needed, nad the verbal consent information should be included in all the STC's documented in CSIM? True or false?
True
Should we proactibvely offer a Retro PCP change to the member?
Never
Once you've done with your grievance documentation, what is the correct option you should chose to finish it? Cancel, Close Case, Save and transfer or Save?
Save and transfer
What are the elements to verify accuracy?
Full mailing address & phone number
A standard PCP change can be requested on any day of the month? True or false?
True
What system is used to document a grievance?
CRM
When a call is unable to authenticate a member's account or is not listed as an authorized call type verbal sonsent from the member's end what STC should we use to document the call?
CP435
What screen's should we check prior to requesting a Retro PCP change?
MC and AI
What classification and intent should be used when we file a grievance for reinstatement transportation ?
Benefits/Transporation- Additioanl Trips