Handbook
True or False
Call Outcomes
Random Questions
IF
100

How Many Days of No Call No Show Are Considered Work Abandonment ? 

3 Days 

100

As long as they can verify City and State , its okay to continue the call without getting the zip code . 

FALSE 


***HIPPA VIOLATION***

100

When a Member States They Don't Have Time To Complete Survey 

Examples *  " I am at work " or " I am Driving " 

Call Back 

100

What Are 3 Forms Of Unacceptable Communication When Calling Out Of Work ?

Voicemails, Emails and Text meassage.

100

If Member is Away At College 


What Should You Do ? 

Ask for another number.

If not, you can mark as Left Message.

200

Which 6 Holidays Are We Not Required To Work On ? 

* New Years Day 

* Memorial Day

* Independence Day

* Labor Day 

*Thanksgiving Day

* Christmas Day

200

As long as the person who answers states they filled out the PRD(Personal Representation Designation ) form , you can speak with them on behalf of the member over 18years old. 

TRUE 

200

CAO Call or Nursing Home

Wrong Number

200

Before Getting PHI , What Do You Want To Adv The Member ?

Call is being recorded for training and quality purposes 

200

If the P/G  states “I already completed the survey for my other children.” 

Give 2 of the main responses you would adv them of

o    Apologize for any inconvenience but advise the parent/guardian that survey must be completed per individual/child. 

o    Advise that it is a requirement for all medical insurance companies that provide coverage for Medical Assistance consumers. 

o    Advise parent/guardian that we will attempt 2 more times to complete survey, then mark as Call Back Later.

300

How Long In Advance Should You Put In A Request For PTO? 

2 weeks 

300

True or False : 

When you reach out to a member who is not available to do survey but the person on the phone states she is his wife , you can continue the call even though there is no " care of" listed. 

FALSE

300

No Dial Tone / Busy Line 

No Answer 

300

How Many Surveys Should Be Completed Weekly ?

60 surveys 

300

If a mbr/Pg says " I didn't pick this insurance " 

what do you as a rep adv? 

  • Advise the member that they have been auto enrolled into the GHP by DHS.
  • Advise the member of their effective date.
  • Advise that it is a requirement for all medical insurance companies that provide coverage for Medical Assistance consumers.
  • Advised the member that they can complete survey now and contact DHS later to discuss other MCO options.
  • Advise the member its to see if they qualify for any additional benefits based on their medical needs not offered by every plan and they can decide later if GHP is the best option for you.
400

 How are Points accumulated

123 Attendance Policy

Point Value

16 min-4 hours     .50 of a point

4 hours-8hours      1 point

Actions

1pt - Verbal Warning

2pts - Writing Warning

3pt - Suspended without pay until Employee Reveiw Board Hearing.

400

True or False : 

When a mbr states they already completed the survey , you do the closing & use call outcome " completed survey" 

FALSE 


** apologize , rebuttal & try to do the survey . 


(they will say anything so they don't have to speak to us) 

400

Customer does not answer, or is not available or if speaking with someone who is unable to complete the survey

Left Message 

400

If mbr 18 or older is unavailable , who are you allowed to speak with ?  

( Care of ) person. 

400

 If a member askes for Id # , what is your response ? 


Contact the mbr service number on the back of your insurance card , they will further assist you. 

500

Employee Eligibility: The FMLA defines eligible employees as employees who:


(1) have worked for the employer for at least 12 months;

(2) have worked for the employer for at least 1,250 hours in the previous 12 months


500

If for some reason the 2nd attempt says (completed survey) use Callback Or No answer for call outcome. 

FALSE 

If it says 2nd attempt was completed , then 3rd attempt should be left message ( so we do not reach out again ) 

500

Give at least 4 reasons why call outcome "disconnected" will be used and you send a Snip It to your Supervisor 

* Death 

* imprisonment

* Chose another insurance plan

* No longer lives in PA

500

What are All The Performance Metrics ?

Quality Score - 95% 


Success to Contact Rate - 50% 


Contact Rate - 15% or more


Refusal Rate - 10% or less 


150 dials daily 


60 surveys a week 

500

If Mbr Stated They Haven't Received Their Welcome Packet or Insurance Card , What Would You Advise?

* Adv Effective Date 

* Id Cards Typically Take 10-14 days to arrive after that effective date 

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