Truth or False
If the Medicare number, DOB, and name was confirmed before, the agent doesn't have to ask again during the enrollment process, it can be skipped?
False, the information has to be confirmed or asked in the application.
The agent stated their first and last name with the beneficiary, another person which is the friend joins the call to assist the member with their medications.
Is the greeting required again?
Yes, you must reintroduce yourself if another party joins to call.
A member moves to a new area but their current plan is in the same service area. Do they have the opportunity to make changes to their plan?
No, the SEP isn't valid since they are in the same service area.
How long can you place the caller on hold?
You have up to two minutes.
Do you have to state your name and phone number during the SOA again if a caller doesn't have a pen or paper to write down your information?
Yes, this is required even if the caller doesn't have a pen or paper.
A member can use an SEP anytime they want to change plans.
False, they have to have a valid SEP in order to switch plans.
An agent places a caller on hold without asking for permission. Is this a compliance requirement that will result in an auto fail?
No, it's a soft skills expectation.
A member loses employer or union coverage. What type of enrollment period can we use?
Loss of coverage SEP
What should you avoid doing while a caller is speaking?
Avoid talking over or interrupting the caller.
What must you obtain before continuing with a recorded out bound call?
Consent to record and two pieces of information.
An agent can discuss plan details before completing the SOA.
False
What must you obtain before submitting an application
You must get consent to submit the application.
A member qualifies for Medicaid or extra help for the first time. What type of enrollment opportunity do they receive?
LIS/Medicaid SEP
What must an agent do before placing a caller on hold?
Ask for permission
Name one way an agent can build trust with a caller?
Stating their first/last name and they are a licensed agent. & stating the commitment statement.
If the caller's PCP is not showing up in our system the agent can move forward without a PCP if it's a PPO plan.
False.
What pieces of information must be captured when reviewing medications besides the drug name?
Quantity/frequency, drug restrictions, pharmacy network, deductibles, and drug phases.
What was the last day for member's to make changes to their plan due to non renewal?
If you are needing to transfer a caller to another department, what two things should you explain/give?
Explain the reason for the transfer and the department you are transferring to phone number.
What is our full commitment statement?
I will be happy to assist you today, I am going to gather your information. I will need to ask you a few questions to identify your needs. Find solutions to those needs, & make sure you are protected today. How does that sound?
It's okay for you to discuss a member's personal information without confirming POA, if the caller is a family member?
No this is a HIPPA violation.
(Will this result in an auto fail)? An agent skips all the application questions because they are listed as optional.
Yes, this will result in an auto fail, questions in the application are required but optional for the members to answer.
How often can a member make changes to their plan if they are currently living in a nursing/rehab facility?
Your chance to join, switch, or drop coverage lasts as long as you live in the institution
Name one way an agent can demonstrate professionalism during a call.
Use the callers name/build rapport/use professional language.
What are five needs assessment questions?
What's your monthly budget, do you travel often, what medications are you taking, what's the name if your hospital, and PCP?