PCP change
Nombra los 3 tipos de procesos de PCP change
Standard - Retro - Open Panel
Which process you must follow when members stop answering?
Non-responsive Caller Process
What do you need to ask if the call comes in authenticated with a Careplus ID?
Name, Full address, PH#
Cuando se puede solicitar un Standard PCP change
Any day
Which process can you follow to obtain translator services?
Voiance interpreter access
What do you need to ask if the call does not come in authenticated?
Name, Full address, PH#, CarePlus or Medicare ID, 2 other authentication elements
Cuales son los requerimientos para que se pueda realizar un PCP change
first 5 days of the month, Member has not seen PCP in current month, Member has not been hospitalized
In which process do you find where you must transfer Grievances?
CRM G&A Transfer Guide
What do you n eed to ask if the call comes in authenticated with a Humana iD?
Name, Full address, PH#, CarePlus or Medicare ID, 2 other authentication elements
Menciona 3 escenarios donde aplica un Retro PCP change
PCP has no available appointments
Dissatisfaction with current PCP
New enrollees preffered a PCP on the app had a close panel
Associate failed to process a change and the issues is identified after 5 days of the month
Where can you find what vendor is designated to one specific Region?
Nap tool
What does HIPAA means?
Health Insurance Portability and Accountability Act
cual es el STC correcto
C0329
In which process do you find the new Greeting and Closing?
CarePlus Call Flow
What are the 5 authentication elements?
DOB, Zip code, Member's plan, PCP, Mother's maiden name