Processes
The FCC statement, which must be given within the first minute of every call.
The recorded call disclosure:
"This call is being recorded for quality and compliance purposes"
In which section of the SOS Disability Screening do we ask about the member's non-medical situation?
Pre-Disability Screen
The appropriate rebuttal when a member asks for further information, but has not yet verified PHI.
"I completely understand. {HEALTH PLAN NAME} has contracted our company to help see if certain members may qualify for additional benefits. Centauri Health Solutions assists individuals in applying for certain government benefit programs based on their eligibility, such as disability benefits through the Social Security Administration. If you potentially qualify, we assist in the application process. If you do not, we simply close the case. We will be able to determine through a screening whether you may in fact qualify."
We will always search this first to attempt to pull up a member's account.
Phone number on Livevox panel
This is the section in Compass where we will obtain verbal consent before submitting the ODR.
Documentation Completion
The forms of PHI we want to verify within the first 2 minutes of every call.
DOB, Full Mailing Address, Phone Number
True or False: We will only gather household income if the claimant does not receive food stamps.
TRUE
3 Strike Rule
Used for Irate members only:
First strike advise you cannot continue call if they continue their behavior
2nd strike, second warning + message your TL
3rd strike, politely end call + email TL member's information and details of what occurred during the call
The Call Result should always be placed here.
Contact Management under Primary Contact
These pages of the Adult ODR must uploaded to Compass.
Re-Entry Number Page
Overview Page
Final Review Page
Confirmation Page
Receipt Page
For child cases, we must ask for this in the beginning of the call before we begin the screening.
The parent/guardian's first and last name and relationship to the child
True or False: When completing the PDS, if the claimant tells us that they applied for benefits on their own, but that it has been over 30 days, and they have not talked to anyone from SSA we will select NO the claimant does not have a pending application.
TRUE
Fill in the blank: ____ Control is a necessary skill to ensure that you stay on topic and complete the screening efficiently.
Call
Additional steps in Compass for a Fast Track case.
Add an alert, and add TERI/CAL task
These pages of the Child ODR must uploaded to Compass.
Re-Entry Number Page
Final Review Page
Confirmation Page
Receipt Page
When the Fee Agreement is utilized.
Members who disenroll from the Health Plan, Champion Cases
When applicable, SOS must also upload the completed copy of the SOS Accept Calculator to the Documents tab in Compass. What document type will SOS use for the Accept Calculator?
BB Screening Guide
Consultative Talking Points
If we do not continue the screen- asking the member if we can follow up in 60-90 days, providing SSA phone number/website (self-direct) and advising to call Centauri back.
Where in Compass will you request for documents to be mailed to the claimant, such as the original outreach letter or the paper consent form?
Correspondence Library
When completing an ODR for a child, who's contact information: Name, Mailing Address, and Phone Number should be entered in the 'Information About You' section?
The Parent/Legal Guardian
Why we offer the E1696 on eligible cases.
Authorizes Centauri to begin working on claimant's case right away, the E1696 is faster than waiting for the paper consents and expedites the process.
What is the next step in the SS process after the application (ODR) is submitted to SSA?
Claimant will have a phone interview with their local SSA Field Office
Rebuttals to ease a member's Legitimacy Concerns.
Offer to resend the letter, refer the member to our website www.centaurihs.com, provide their Health Plan's customer service number and advise them to speak with a supervisor to verify our partnership
If we start the ODR, but we are unable to finish and submit, we must ensure we add this number to the Application Tab in Compass so another SOS can pick up where we left off on the online application.
The Re-Entry Number
When we reach the Confirmation Page for both adults and children, in addition to printing this page to be uploaded to Compass, what additional steps should we take?
Highlight the text and copy and paste into a note in Compass.