Call Flow
What is the Greeting?
Good <morning/afternoon>. Thank you for calling Unitedhealthcare for <groupname> for retirees. My name is _____. How may I help you?
What must be obtained for HIPAA
Full name DOB full address
What are two ways you can access the tool kits?
SharePoint MIRA
What Job Aid would I find the steps to verify HIPAA for a third party being on the line?
HIPAA
What are "network-based" plans?
HMO, HMO-POS, PPO
After fulfilling HIPAA requirements, What are the next 3 items you would gather from the consumer?
Phone number, Email, PTC
What must be obtained from the third party caller for HIPAA?
Third Party's full name, Relationship to the prospect.
Where can you find information regarding enrollment timeframes set by groups?
The Toolkit
What Job Aid would I go to to find the steps for the NPPO provider lookup process?
800 Series Medical Coverage
What is original Medicare?
part A and B
What Steps are included in the needs assessment?
Initial needs, Doctor List, drug list, Determine plan.
What are the 3 things we are looking for during the provider needs step?
PCPs, Specalists, Hos/Facilities
What Tab in the toolkit will we find information about the types of plans offered by the specific group?
Product Tab
What Job aid would I need to access if the retiree asks what reward offers their plan will pay for?
Group retiree Wellness benefits
What is NOT covered by original Medicare, that needs to be purchased separately?
Part D
What is the goal of the solution presentation?
Link plan benefits to retiree needs
What are the 5 quality points for the medication Step?
Name, Dosage, Frequency, Quantity, Form
What Resource do you find the eligible dependents for the retiree plan?
Toolkit
Where would I find how to be compliant on enrollment calls?
Quality Guidelines
What is the service area for a NPPO plan?
All 50 states.
When do you read the baseline benefits?
After solution presentation.
What do you do if you can't verify HIPAA
give the consumer basic Medicare information.
If a retiree is listed in the RF, but the spouse is NOT, and the Eligibility source is RF or Verbal, what do you do?
Proceed with the call. - Go off verbal Attestation
Where would I find the steps to fill out the provider out reach form?
800 Series Medical Job aid - Provider out reach tab.
What is the Late enrollment penalty?
consumer doesn't enroll in Part D when first eligible, break in Part D coverage for more than 63 days