UCARD
What can members NOT purchase with their Ucard?
out-of-pocket dental, medical, prescription, or vision expenses
plan premiums or copays
alcohol, tobacco, firearms, fuel
cash back during in-store check-out or for returned goods
SOURCE: KM2089605
A provider calls and needs to know an INN DME provider to send a PA to for a wheelchair on behalf of a member. Can you assist or do you transfer the provider to the Provider Line? How are you HIPAA verifying?
You can assist the provider in locating a DME provider thats INN after the provider verifies:
Member first/last name
And/or DOB, complete address including city, state and zip code.
Providers name (first name, first initial of last name) and one of the following:
Provider TIN
NPI/NCPDP number
Name of facility (city and state)
HIPAA Caller Type- Provider KM1005726
Why is it important to check in with a member during extended hold times? What is the duration of acceptable hold times?
Checking in at least 1-2 minutes after placing member on hold reassures the member that their issue is still being worked on, reduces frustration, and shows empathy. This helps maintain trust and improves overall satisfaction, which positively impacts NPS and UES.
Situational Guidelines- Hold KM1004317
Why should you avoid jargon when speaking with members?
Using jargon can confuse members and increase perceived effort. Clear, simple language makes the process easier and improves UES.
Call Etiquette and Positive Engagement- KM2097453
What is one way to reduce repeat calls from members?
Provide complete and accurate information the first time, confirm understanding, and explain next steps clearly.
Embrace the Gray- KM1013755
How can members check their transaction history?
Using their mobile app or member website
Calling member services
How long is an AR or ROI (release of information) valid on members account?
2 years if completed on member portal or sent by mail
If entered in maestro as verbal release of information- 1 year from date that it was entered.
HIPAA Caller Type- Authorized Rep KM1007997
What impact does offering a final assistance question (“Is there anything else I can help you with today?”) have on NPS?
It ensures the member feels fully supported and valued. This simple step can turn a neutral experience into a positive one, increasing the likelihood of a promoter score.
Greetings and Closings- Index KM1008074
Why is empathy critical during calls?
Empathy helps members feel understood and valued, reducing frustration and increasing trust. This emotional connection strongly influences NPS.
Greetings and Closings Best Practices- KM1337125
What is the benefit of summarizing the call before ending?
It reinforces clarity, confirms resolution, and shows professionalism, which increases trust and satisfaction.
Situational Guidelines - Engaging Third Parties KM1229955
When members are calling for their Ucard balance, what should we also inform members after providing them with their current balance?
The expiration date: "your balance is ___ amd those credits expire on ___"
Self-service options: mobile app, member website, calling the number on the back of their card.
If a prospective member is calling and is not an active member of UHC and has submitted an application, do you need to HIPAA verify?
Yes. First/last name and DOB.
KM1005614
What does NPS measure and why is it important?
NPS measures member loyalty and likelihood to recommend the service. It’s important because it reflects overall satisfaction and trust in the organization.
Member Experience Surveys- KM1004517
What phrase or action can leave a lasting positive impression at the end of the call?
Using a warm closing like: “Thank you for calling today. I’m glad I could assist you. Please reach out if you need anything else.” This reinforces care and professionalism, boosting NPS.
Greetings and Closings Best Practices- KM1337125
Embrace The Gray- KM1013755
What should you do if you cannot resolve the member’s issue immediately?
Explain the next steps clearly, provide a realistic timeline, and reassure the member you’ll follow through. This reduces uncertainty and effort.
Embrace the Gray- KM1013755
Do we offer rewards? If so, what is the SOP?
Only discuss rewards If the member brings up rewards or has a Next Best Action on their account.
If rewards are discussed during a call, you may mention all available rewards on their activity list.
Rewards Index KM1740568
If a call comes in IVR verified, but is not the member, and the caller is not listed as an AR on the members account, how are you HIPAA verifying?
Ask to speak to member and verify first/last name, DOB and member ID/complete address
Get verbal consent to speak to caller, ask if it's okay to put that caller on the account
Why is it important to avoid dead air during calls? What can you do to prevent it?
Engage with the member while you are researching, documenting, and trying to resolve the member's issue.
"How is the weather where you are located?"
"Do you have any upcoming plans?"
"I hear you have a dog with you, what's their name? What kind of breed is he/she?"
Situational Guidelines- Call Silence KM1004370
What should you do if you notice a member sounding frustrated after a long hold?
Acknowledge the delay, apologize sincerely, and reassure them you’re working on their issue. This shows accountability and care, improving satisfaction.
Embrace The Gray- KM1013755
How can you reduce perceived effort for the member when they need multiple services or referrals?
By explaining the process clearly, assisting with referrals directly when possible, and avoiding unnecessary transfers. Proactive guidance makes the experience feel easier, improving UES.
Referral Requirements in 2026- KM1006108
What self-service options can we provide members to check their Ucard balance?
Using the mobile app
Logging into the member website
Call the number on the back of their card and say "balances" to the self-service automated system.
Members that come through the IVR system verified, how do you HIPAA verify the member?
Confirm first/last name
Thank the member for using the automated system
HIPAA Index KM1007482
HIPAA Guidelines For All Callers KM1783351
Why is listening more than talking important?
Active listening helps you understand the member’s real needs, prevents unnecessary effort, and makes them feel heard and respected.
Call Etiquette and Positive Engagement- KM2097453
How does accurate documentation impact member experience?
It prevents confusion, ensures proper follow-up, and builds trust. Inaccurate documentation under the correct intent in the members account in maestro can lead to repeated calls and higher effort, lowering UES.
The Importance of Proper Documentation- KM1010851
If a member expresses interest in CHOICES but later mentions ECF, how should you document and disposition the referral?
Document both interests accurately and disposition based on the member’s final choice. If they want to self-refer for ECF, note that clearly and do not mark them as ineligible for CHOICES unless confirmed. Accuracy prevents confusion and improves trust.