QA
How long do you have to refresh your hold with caller?
2 Minutes Max
TRUE OR FALSE
If member is calling to update income and you see a renewal in progress.
Just update income and ignore renewal in progress
FALSE
Always confirm in notices if there was a renewal notice sent out. If so you must complete renewal with member. You cant ignore anything in an account
If member is enrolled into OneCare, SCO, or PACE, who would they need to refer to for transportation?
They have to contact their plan for transportation requests.
SCO(Senior Care Options), PACE, or One Care(ICO)
Conference in Language Line to get an intepreter to help you with the call
True or False
Can I skip application questions while completing application/renewal?
False
We must ask all questions in application while completing a renewal or new application.
*The only time we can skip questions is when completing a RAC and application opens to the beginning of application rather than specific section.
What is the max dead air time you can have on a call ?
30 seconds
How long does a member have to respond to a non-auto renewal ?
45 days
What coverage can the member have to be eligible for PT1 Services?
MassHealth Standard, CommonHealth,, and CarePlus
A CAC or Navigator is on the call, what extension would you transfer them to ?
MA_Assister Mainline
If member is inquiring about PCA services, what is the first check you need to and who would you refer to ?
Confirm member has STD or COM coverage, and refer to a PCM agency in their area
If you just submitted a application or renewal for a member, what information are you required to provide them?
Advise member of potiental coverage and any active RFIs
Member calls, aid category 06 and AA PAC. What are the next steps member needs to do ?
Complete HIX Application
TRUE OR FALSE
Any active MassHealth Provider can request PT1
TRUE
( Does not need to PCP, can be any provider that is active with MH)
Member has HSN/PHSN coverage and would like to know more about it, what campaign would you transfer to ?
MA_HSN Main, option 1
Yes or No
Member has MSP questions about coverage, can I transfer to MSP unit?
No, Pull up MSP job aid on Knowledge Owl.
MSP unit cant determine eligibility or answer questions regarding MSP. They can only assist with payment issues with MSP.
When should you be saying thank you to the member ?
Before placing on hold and when returning from hold
For a specialty disability renewal, What type of notice would you see in MA21.
PACA-REV-DB
If member needs to expedite their PT1, what can we do ?
We can only educate them to talk to provider and have them call the MH provider line.
( Member cant do anything, only provider)
Member received a letter stating assets are being held by MassHealth, which unit would you transfer them to ?
Estate Recovery/Third Party Recovery 1-800-754-1864
If you noticed in Verint you were 1 minute late to sign into five 9. What should you do to fix adherence?
Reach out to COL to advise you were late or was having a system issue
How would you verify an individual calling for an under 18 year old when they are alone in a HIX account?
You will need to find who signed the application (located in the application summary, that person can speak on behalf of the under 18 year old.)
When would you need to play consent audios to members?
Renewal, application or job update form
* Dont need to play for RACs
TRUE OR FALSE
Member has inactive coverage on MMIS, just completed renewal. If you are not HP trained, can you transfer to HP for enrollment ?
FALSE
Takes 24-48 hours for MMIS to receive updated information
True or False
If member only has EB aid cat they can enroll into a health plan
False
Based on aid cat they arent eligible for a health plan, providers would need to bill fee for service. If member is needing a plan they will need a new application to get a new aid cat to be able to enroll into plan