ROI
What does ROI stand for?
Release of Information
When logging in at the beginning of the day before you come to training, what do you need to do?
Kronos - Punch In
Status Code - Training
T or F: It is optional to create cases and caseflows on every call
False! Creating a case or caseflow is REQUIRED on every call.
What tab in Salesforce can we search for any member within Select Health by the Subscriber ID, First Name, Last Name, DOB, etc?
Member Search Tab
When verifying ROI, what do we have ALWAYS have to say?
"For security purposes can I have you verify…"
You are training and are leaving for the day. What do you do?
- Kronos - clock out
-SF-Phone System Log Out
Using ID#801801801 - If a provider called in regarding medical benefits for this member, what would the Case and Sub type be?
Case Type: Benefits
Sub Type: Medical
When you answer a call and accept, a policy pulls up. What is the first thing that pulls up before accessing the members policy?
ROI Validation Screen
When a provider calls in, what 3 things do we need to grab from them?
Name, Office/Hospital they're calling from, callback number
Sarah owns her own business and is looking to shop for a insurance plan. Which would she qualify for?
Individual
What would the Case and Sub Type be if a provider were to call in asking about a members effective dates?
What tab in Salesforce would you click into to find the members effective dates?
Case Type: Eligibility / Enrollment
Sub Type: Enrollment Information
Eligibility Tab
What tab can we click into to see if a member has more than one insurance policy?
COB Tab
What are the identifiers to complete ROI and how many identifiers should be listed when verifying ROI?
Identifiers: Full Name, DOB, Last four of SSN, Full Address, Policy ID, and Phone Number.
3 Pieces of identification are required
Carol just qualified for disability through Social Security before they turn 65. Which plan would they qualify for?
Medicare
What is the document tab used for?
The document tab will display information on communications that have been mailed out to the selected member/provider
What tab has the past interactions with the member/provider including icons varying by interaction channel?
Service History Tab
What does PHI stand for and why is it important?
Protected Health information. It is the demographic information which is used in many company's especially in the healthcare professional which collects information to identify an individual and determine the appropriate care.
How does a Deductible work?
How does an Out-of-Pocket work?
DED is the members responsibility before the insurance applies the benefits.
OOP is the maximum dollar amount per year the member is responsibility for covered services. The oop includes ded, copays and coinsurance. Once the oop max is met then the member is covered 100% for the rest of the year for covered services.
Using ID# 802787159 - Alexandra Lopez - DOB 4/13/2002
What are the effective dates for each policy?
801113937: 5/1/2016 - 9/30/2018
802017387: 12/1/2018 - 5/31/2023
802787159: 1/1/2024 - Current
ID#802201445 - Nicholas Dunyon - DOB 05/18/1995
Is this member active or terminated?
What line of business is this plan and how many people are on the policy total?
The member is active.
LOB: Individual
5 people total on the policy