HIPAA
True or False: HIPAA does not need to be verified on outbound calls
False
Acknowledging the Customers concern is Important because?
A. It empowers you to let the customers feel we’re worth the money they spend on their premiums
B. It empowers to let the member know you are there to partner with them in order to resolve their issue rather than being another obstacle for them to overcome.
C. It empowers you to help the customers use the left side of their brains’ which makes them more logical and organized.
B. It empowers to let the member know you are there to partner with them in order to resolve their issue rather than being another obstacle for them to overcome.
Identify the example of best practice phrase
A. Where are you calling from?
B. I can help you with that, let me just gather some additional information from you…
C. I need the ID number you’re calling about first.
D. Okay, can I have your name?
B. I can help you with that, let me just gather some additional information from you…
1) How much is the OTC benefit for MMA members? 2) How much is the OTC benefit for FHK members?
1) $25
2) $10
What does PHI stand for?
Protected Health Information
If the caller is calling for themselves, you will need to ask for how many qualifiers?
Three qualifiers
Why is offering additional assistance at the end of the call so important?
A. It allows you to stay on the call longer with the member so that you have less calls for the day.
B. It gives the member an opportunity to ask additional questions.
C. It lets the member know you are there to help with any other issue they may have.
B. It gives the member an opportunity to ask additional questions.
C. It lets the member know you are there to help with any other issue they may have.
Identify the example of a best practice phrase:
A. You may receive a survey about our call. You don’t have to answer it… only if you have time. We’re having a contest or something, so we have to ask everyone.
B. As a reminder, you may receive a survey.
C. You may receive a survey about our call. I’m always looking to improve my service, so I’d appreciate you letting us know how it went.
C. You may receive a survey about our call. I’m always looking to improve my service, so I’d appreciate you letting us know how it went.
What is the name of the program that offers incentive (gift cards) to members when they achieve health goals?
Healthy Behaviors Program
Where does a member need to call when they want to be part of the LTC plan?
Elder Affairs
Member's Daughter is calling on behalf of her dad who has been admitted to the hospital. She provides you all the details to verify HIPAA, can you proceed without getting verbal authorization from the member? If yes, explain how you document it on the HIPAA verification screen
Yes, if using best interest, must select informal representative
One of our goals is to improve our voice of the customer survey scores so that…
A. You have the opportunity for additional PTO
B. You have the opportunity to receive 100% QIP payouts for your department goals!
C. You have the opportunity to receive gift cards from Anthem leadership.
B. You have the opportunity to receive 100% QIP payouts for your department goals!
Identify the example of a best practice phrase:
A. Okay you are all set. Thanks for calling have a nice day!
B. Have I fully resolved your issue today?
C. I hope I have resolved your issues today, thanks for calling and have a nice day!
E. All of the above.
B. Have I fully resolved your issue today?
1) How can a MMA/CHA member's parent sign up their child for tutoring services?
2) How many hours a week is this benefit?
1) send an email with the member's name, ID number and parents email to info@simplyhealthcareplans.com
2) 2 hours a week with prior authorization
What is the difference between Responsible Person and Designated Representative?
Responsible person is like a parent, legal guardian, spouse social worker, or caretaker of an individual and is responsible for the person in some capacity.
Designated Rep is an appointed person that is designated by the member to speak/make decisions for them. This person often has no legal responsibility for the member such as sibling or friend.
Please put the steps in order when using the HIPAA verification disclosure tool.
1) Walk through the disclosure and verification questions by following the instructions
2)Review the disclosure Matrix to see what you can and cannot disclose
3) Choose the call Work flow
1 Choose the call Work flow
2 Walk through the disclosure and verification questions by following the instructions
3 Review the disclosure Matrix to see what you can and cannot disclose
Why is closing the call effectively important?
A. It allows you to end the call with a lasting positive impression.
B. It helps to eliminate Inline quality errors tied to vague or no call closings
C. It shows appreciation for our customers and their business.
D. All of the above.
D. All of the above.
Which of the following are examples of how to close a call positively and sincerely?
A. Use an appropriate closing based on the inquiry.
B. Use empathy statements to acknowledge any using situations or issues discussed.
C. Use natural language.
D. Use positive phrasing that shows appreciation.
E. All of the above.
E. All of the above.
What is the name of the benefit program that is for Maternal Child Services program for all expectant mothers?
Taking Care of Baby and Me
True or False: When updating the phone number on the account, the member must also contact DCF to update their phone number with them as well.
True
What does HIPAA stand for?
Health Insurance Probability and Accountability Act
Promoting the voice of the customer survey is important because…
A. It gives the member something to do in their free time.
B. It empowers you to let the member know we’d like to hear about their experience with you.
C. It gathers data about the kind of people who like to complete surveys.
B. It empowers you to let the member know we’d like to hear about their experience with you.
After you verified the caller, what is the next thing you should do? (more than one answer possible)
A. Let the caller know that you will pull up their information and get their issue resolved.
B. Verify the caller’s mailing address
C. Acknowledge the caller and continue to offer assistance.
D. All of the above
E. A and C
E. A and C
Which type of specialist do not require a referral to be seen with simply?
Well child visits
Behavioral Health Services
OB/GYN– Pregnancy, Well-Woman visits
Optometry
Acupuncture and Chiropractic
*Simply Florida Healthy Kids requires a referral for all specialty services.
What is the difference between an EOB and an EOP?
Explanation of Benefits (EOB): A statement sent by a health insurance company to covered individuals explaining what treatment and/or service were paid for on their behalf.
Explanation of Payments (EOP): A document that notifies the provider that certain procedures are being fully or partially denied or paid based on the member’s benefits and/or coverage with Amerigroup