Scenario 1
A member called in, saying she is returning a call. What HIPAA verification do you need?
Inbound call
Full name
DOB
Member ID - If unavailable
Address and phone number
You called the member back due to disconnected call. What are the HIPAA verifiers you need?
During an inbound call, a member provides:
The member does not know their Member ID.
Answer: Yes. When the Health Plan/Product ID is unavailable, DOB plus Address and Phone Number may be used as an approved alternative.
For outbound calls, the member's full name counts as one of the required HIPAA verifiers.
Answer: False.
Call came in in Genesys as Outbound call, what verification do you need?
- Confirm full name as it appears in the system
- DOB
- Address or
- Mbr ID
If a call came in (Inbound), does confirming the name counts as a verifier? Yes or No?
No
An authorized representative calls and correctly identifies themselves.
The representative verifies:
But cannot provide the Member ID.
Can the call continue?
Answer: No. The representative must provide two valid verifiers. If the Member ID is unavailable, they may verify Address and Phone Number as the alternative.
For inbound calls, verifying you have reached the correct member counts as one HIPAA verifier.
Answer: False.
Member provided 1234 Spencer St Detroit MI, is this a complete address?
No, zipcode is missing
Third party calling, saying we are calling her Dad. How do we verify HIPAA?
An agent says:
"I see your address as 123 Main Street. Is that still correct?"
before completing HIPAA on an inbound call.
What compliance issue exists?
Answer: The agent disclosed member information before HIPAA verification was completed. The member should provide verification information rather than having the agent state it first.
A member passes HIPAA and then places the call on speakerphone. The agent hears another person giving responses.
Answer: Not until verbal authorization is obtained from the member allowing that person to participate in the call.
You call a member on an outbound campaign. The person who answers confirms the member's full name and date of birth but refuses to provide any additional information.
Can you proceed with the call? Why or why not?
Answer: No. For outbound calls, the member's full name must be confirmed, plus two additional verifiers (DOB, Address, or Health Plan/Product ID). DOB alone is insufficient.
A member passes HIPAA and then says:
"My daughter handles everything for me. You can talk to her."
What should the agent do next?
Answer: Obtain verbal consent from the member authorizing the daughter to participate before discussing PHI with her.
Do you need to say the address for the Outbound call to complete HIPAA verification?
No, member has to confirm and say the complete address in the call
A member calls inbound and verifies:
Can the agent discuss benefits?
Answer: No. The member's name and confirmation that you are speaking with the correct person do not count as a HIPAA verifier. Two valid identifiers must be obtained.
On an inbound call, the member verifies:
The member cannot provide their address or Member ID.
Did HIPAA pass?
Answer: No. Phone number alone is not an approved verifier. If the Member ID is unavailable, the approved alternative is Address and Phone Number together.