HIPPA Verification
What may an SC state about a member’s name before verifying HIPAA?
First OR last name only
Responding 'Oh…okay' to expressed hardship is scored as what?
Lack of Empathy/Sympathy (Autofail)
Recording disclosure must be stated at what point?
Before requesting or releasing PHI
When may SC skip offering a virtual visit?
If member agreed to F2F and availability exists or no eligible for VV
After providing reluctance statement, what must SC do?
Pause and allow the member to accept HCV or decline again
What address information may never be stated before HIPAA verification?
Any part of physical/mailing address
Remaining on the line after the call ends for more than how long is a defect?
More than 2 minutes
When offering TCPA consent, what is required?
Provide correct TCPA scripting (SCs may utilize their own verbiage if it does not change the meaning or requirements of the TCPA talking point)
How long is an HCV face-to-face visit?
45–60 minutes (60–90 with interpreter)
Member fears COVID-19. What status must be selected?
Public Health Crisis (for COVID-19 concerns only)
Which is allowed prior to HIPAA verification: updating a phone number or confirming email?
Updating a phone number only
What happens if SC writes profanity in account notes?
Professionalism violation (Used Profanity - AutoFail)
SC offered the rewards card to a member who is not eligible to receive one without correcting results in what defect?
Rewards Card – Ineligible (Autofail-Legal/Client Scripting)
When must SC attempt to handle reluctance?
All calls when a member refuses a HCV.
True or False. SCs are required to offer toll free number on all calls.
False
SC failed to HIPPA verify and scheduled an appointment. Is this a HIPPA violation or just a regular deduction?
HIPPA violation
What happens if an SC intentionally, and inappropriately disconnected the line?
Falls under unprofessionalism and can lead to disciplinary actions.
What must happen for BCBS members requesting DNC?
Warm transfer to BCBS Member Services
Is offering only the rewards card and/or VV sufficient as reluctance handling?
No, we must add a value statement
True or False. "Licensed HealthCare Practitioner" should be mentioned at least twice on every scheduled/rescheduled call.
False (should be mentioned at least ONCE)
What error occurs if the SC leads a non-member to agree to schedule?
Non-member leading error
What happens if an SC used profanity when speaking with a member/non-member?
Leads to immediate disciplinary action (Company Code of Conduct violation)
What step needs to be followed for a member who already has pre-selected SMS communication preference but needs to update mobile number?
Update mobile number and read all applicable SMS disclosures.
Handling reluctance with an unauthorized non-member causes to lose how many deductions?
4 points deducted
What should be offered to a member who stated they do not have PCP?
SC should ask if they need help finding one and offer to connect them with MS.