Random Audits
Quality Call Audits "Confirm Identity": We must confirm the (blank and blank) of both the member and person we are communicating with or it's an Auto-Fail.
First and Last Name (of the member and parent/legal guardian)
We should be noting all cases we assist with. Call/Case note must specifically state whether the case is being (blank or blank) and the reason why.
Accepted or Self-Directed
What is the break allowance per a 4 hr working shift?
15 minutes
Most cases from HP Members that are pending are accepted by us. What pending case do we not accept?
ALJ (Hearing Level) Pending Cases
Wrap-up status is an unproductive phone status and is intended to be used to document notes after a successful phone screen/app completion. What is the wrap time allowance?
5 Minutes
What is the maximum amount of time allowed to place someone on hold?
2 Minutes (must check back in with member, thank them for holding and ask to place on hold again if additional time is needed)
What should all Bilingual/Translation calls be logged as in LiveVox? Regardless of accepted or self-directed?
Do not speak English (otherwise, if an accept, Call Miner will record the call, and will lose points)
When we clock into Dayforce, we must be logged into our LiveVox phone system no later than...
At the start of our shift (our phone hours should match our timesheet)
Because SSI will automatically become eligible without a medical decision at a certain age if they meet income/resources, what is the max age we will screen?
64.50 years old
What "script" is used when we self direct?
Consultative Talk Points
When we handle an incomplete screen and member would like to be called back later, what is the correct LiveVox Termination code to select?
Incomplete Screen
List 3 main Doc Type we must save to Documents after submitting an application.
Re-Entry Number Page, Confirmation Page, Receipt Page
If we do not provide consultative talking points to a member, we must change close reason to:
Refuse Consultative
For children cases, what is not counted as part of resources?
Retirement Funds, 401K (that belongs to the parent/adopted parent)
Which Health Plan requires an OPT-IN Form returned back to the HP before we can assist?
(California) KAISER
Call Miner, speech system, pays attention to important words/phrases that all specialists should use during calls for consistency. It looks for 6 criteria that determine the scoring. Provide a minimum of 4 criteria.
Recorded Call, PHI Verify, Politeness, Ownership, 3rd Party, Verbal Permission (Extra 100 points per additional criteria provided - 200 max)
"Enough Info" - At a minimum, the following must be gathered for children's cases?
1 symptom with frequency, 1 limitation, Milestones/GABS, and treatment source info
What is the passing score % for any of our Quality Audits?
92%
All Federal tax refunds and advanced tax credits received are not counted for how many months?
12 Months
When we received a warm transfer from a client HP, we must update the Health Plan Referral Priority in Compass Summary to:
Phone Referral (and don't forget to click on SAVE!)
Quality Call Audits "Compass Processing": what happens when information not provided by the individual is entered into the application?
Auto-Fail
"Enough Info" At a minimum, the following must be gathered for adults?
Adults: 2 ADLs, 1 limitation, 1 symptom with frequency, treatment source info
What are the 3 main requirements that SOS must fulfill along before achieving monthly PFP (Bonus Structure)?
90%+ Attendance, 4.00 Accept Avg, Approval/or Good Decision (*also cannot be on progressive discipline during bonus discipline or time of payout)
If a person is 59 1/2 or older and eligible to draw Social Security benefits, what resource is not counted?
401K
There are a total of 6 Scorecard goals. List at least four goals.
Lives Impact/Accepts, Good Decision, Call Miner, Quality Acct Audit, Utilization, Rewire