CENTENE DENTAL JEOPARDY

Systems

100

What system was upgraded over the weekend?

Enterprise 

200

True or False: Enterprise upgrades were applied to the provider and member call screens/profiles?

True 

300

Name the two new tabs that were added to Enterprise 

1. Member Communication Preferences Tab  

2. Member Enrollment History Tab 

400

What existing features in EP were upgraded?

1. Member and Provider HIPPA Verification 

2.Member and Provider Follow - Ups 

3. Provider Location 

500

What PHI identifier was added to the Member HIPAA Verification Screen

Members Phone Number

PHI

100

How many pieces of information need to be verified for a member?

Three

200

How many pieces of information need to be verified for a provider?

Two 

300

What identifiers can be used when verifying a member account?

• ID Number (-01, -02, suffix required for Ambetter members).
• Date of Birth
• Full Name
• Full SSN 
• Complete Address (includes city, state and zip code)
• Phone # (if applicable)

400

What identifiers can be used when verifying a provider?

• Name & Tax ID Number
• Name & NPI Number
• NPI Number and Tax ID Number

500

True Or False: Providing information to a provider about the member's active status before verifying three pieces of information is an automatic PHI fail. 

True 

PRG

100

What does PRG stand for?

Plan Resource Guide 

200

What PRG templates were recently updated? 

1. Member Not Found

2. FAP Tool Doc 

3. Friendly Feedback

300

Where is the member not found document located on the PRG?

Member Eligibility Process

400

Where is the appeals cheat sheet located at on the PRG?

General Documents-->Additional Resources-->Appeals Cheat Sheet 

500

Which reference document on the PRG gives information about member's being billed for the difference between the total cost of services being charged and the amount the insurance pays. 

Balance Billing 

Time Exceptions

100

What are time exceptions?

They are activity codes and adjustments that are manually entered by agents to justify an aux code that was approved outside of the set schedule or adjusting a break/lunch that was unable to be taken due to a long call.  

200

Where do time exceptions get entered?

NICE

300

True or False: Anything less than 5 minutes does not have a significant effect on adherence

True: Only submit an exception if you were in the activity code for 5+ minutes anything less than 5 minutes does not have a significant impact to your adherence, and it will be denied by WFM. 

400

How long do you have to enter a time exception?

Up to 5 Days including weekends

500

True or False: When adding activities such as "Off the Phone" "Meeting" Etc. you must leave a comment

True: Leaving a comment is mandatory for all activities! If you were approved by leadership, you can put something along the lines of “Approved by (Leader’s initials) Approved by ER” or "Approved by Ebonee". 

Reminders

100

True or False: You must utilize the silent hold protocol on all calls and set the expectation anytime you are placing them on hold

True

• Everyone should be utilizing silent hold which is you pressing the mute icon on Avaya. 

200

True or False: I can go to lunch and break early/late

False: You are required to take lunch and break as scheduled on NICE, unless you have prior approval from leadership, or you are unable to go due to a call. 

300

True or False: General Chat should only be used when you are on an active call

True: Any questions you have when not on a call can be answered in our chat. 

400

True or False: Our hold time is 90 seconds when transferring a call and when the caller wants to place us on hold

True

• Transferring Calls: Advise the caller you will only hold for 90 seconds, and if the rep does not come on the line, you will transfer the caller to the que. You will only warm transfer if the caller is irate, in which case; you will merge them on the line with you and use the script provided.
• Callers Placing You on Hold: Advise the caller you will only hold for 90 seconds, and if 90 seconds passes and the caller is not back; you will state the call close script (“Due to being on hold for more than 90 seconds I am now going to release the call, thank you for calling Envolve Dental again my name is (state your name) I hope you have a great day”. ) and release the call.

500

What state are we required to use call back when needing to assist a member with an outreach to the office?

Louisiana

If you need to call the office to fully assist the member, do not place the caller on hold, Do not conference the member on that call.

Instead, you are to offer the member a callback and call the office in Aux 8 (callbacks) immediately after the call.

• Be sure to advise in the main chat that you have to call a Louisiana (LA) provider and include a brief description of why.
• Example 1: LA provider callback; office stating they are not accepting member’s plan, member appointment.
• Example 2: LA Provider callback; provider education, appeals.