Payments
When a member contacts HAP to confirm how much their dental premium is, where should the CSS check?
A. Policy Tab of the Member 360
B. Financial Transactions > Premium Breakdown
C. Financial Transactions > Financial Transactions
D. Financial Transactions > Payment Selections
B. Financial Transactions > Premium Breakdown
What are the two ways to launch Manage Payment and Receipts Intent?
Answer: Via the Financial Transactions tab or from the Add Task panel
True or False. The Premium Breakdown section provides the details on what portion of the premium is for dental, medical and/or pharmacy coverage?
Answer: True
Which DLP should you reference to assist a member with registering and utilzing the member portal?
A. DLP.CS.103
B. DLP.CS.124
C. DLP.CS.026
D. None of the above
Answer: C. DLP.CS.026
True or False. All plan types allow CSS to update communication preferences, true or false?
True.
When checking the members premium payment history, it’s always important to do which of the following?
A. Filter the data using the appropriate date range
B. Contact a leader to review the account
C. Send a case to M&B
D. Sort the data by Transaction Date
Answer: A&D
There are two ways to launch the Manage Payments and Receipts intent, via the Financial Transactions tab or from the Add Task panel. Which one is best practice?
Answer: Add Task approach is best practice.
True or False. The Financial Transactions section provides a detailed breakdown of invoices generated and payments received on the account?
Answer. True
When a member decides to self-serve on the member portal to complete a PHI form, what intent should be launched and documented?
Answer: GSR
While documenting a Send Correspondence intent, it’s important for CSS to provide two pieces of information to the caller, what are they? (Select all that apply).
A. Location
B. Timeframe
C. Date of Birth
D. Social Security Number
E. Case Number
Answer is: B (Date of Birth) and E (Case Number)
Which system is the source of truth for premium payment inquiries?
Answer: PEGA
What should CSSs do when handling an inquiry related to a premium where no payment has been processed?
A. Document the call with payment details.
B. Select "Not Applicable" in the Payment Successful field to document the call without payment details.
C. Ignore the inquiry and proceed to the next call.
D. Request payment information from the customer before proceeding.
Answer: B. Select "Not Applicable" in the Payment Successful field to document the call without payment details.
What important information can be found at the top of the Financial Transactions tab (Select all that apply).
A. AR Account ID
B. Paid YTD
C. Paid Thru Date
D. Balance
E. All of the above
Answer is: E
True or False. As Customer Service Specialists we cannot assist members with resetting their password.
False
Which of the following are forms of cost share?
A. Copay
B. Deductilble
C. Monthy Premium
D. Coinsurance
E. All of the above
Answer is: A, B, and D.
What day of the month are invoices generated?
A. 5th
B. 10th
C. 1st
D. None of the above
Answer: A
True or False: Before capturing financial information, the Specialist MUST use the Start/End Secure Pause feature located in Genesys to prevent any recording of the Member’s financial information.
Answer: True
Please share your screen to guide the viewers/audience on how to navigate to the payment portal when a member calls to make a payment?
Answer: Have new hire navigate to the portal sharing screen from start to finish.
What is the website/URL a CSS provides to a member when requesting to register their account on the members portal?
Kindly navigate the member to www.hap.org and select Log In.
True or False. The first 10 characters of the claim ID will always remain the same.
True
What date range would be used to filter all invoices and payments for the current year?
Answer: 12/5 – Last day of the month, for the most recent billing period
What should you do if the payment information does not display correctly?
A) Ignore the issue and proceed.
B) Select "edit" to make necessary corrections.
C) Wait for a supervisor to resolve it.
D) Restart the application
B. Select "edit" to make necessary corrections.
Which DLP can assist you (CSS) when a member inquires about the following scenarios?
Navigating Alacriti • Assisting Members With Utilizing the Payment Portal • Updating Member Email on Payment Portal • Processing One-Time Payments • Verify AWD Status • Recurring (AWD) Payments • Delinquent Accounts • Employer Group Payments
Answer: DLP.CS.056
What is the delivery timeframe for correspondence sent by mail?
7-10 Business Days
Which of the following is not Essential Health Benefits?
A. Hospitalization
B. Mental health & substance user disorder services
C. Dentist
D. Emergency services
Answer: C Dentist