HIPAA
For a Basic Redetermination call what are your 2 options for HIPAA verification ?
What is :
True or False ?
We can skip around the priority's so instead of maybe walking the member through the application we can just offer to get them straight to the local counties office
What is :
False
We should never skip option 1 build reassurance with your mbr, confirm you can help them resolve the renewal now by connecting to the state to complete the process. DO NOT mention priority 2 unless mbr declines COLD transfer
What are the four metrics you are reviewed on and their percentage ?
What is :
Attendance : 95 or Higher
Quality : 95 or Higher
Adherence : 90 or Higher
Success vs Contact Rate : 50 or Higher
What is the name of the System we use to Verify eligibility for the State of KY
What is :
KYHealthNet
IF we have an angry member we want to follow what we call the H.E.A.T method , what does this acronym stand for ?
What is :
H : Hear them out
E: Empathize
A: Apologize
T : Take Responsibility
WHEN COMPLETING A DEMOGRAPHIC CHANGE, PCP CHANGE, ID CARD, OR ACCESSING WHPF - WHAT ADDITIONAL PIECE OF INFORMATION MUST BE VERIFIED
IF NOT WILL RESULT IN HIPAA VIOLATION!!!
What is :
What 2 states can we walk the member through their application ?
What is :
KY
CA
Are we able to update the members physical address ?
What is :
No
What is State Uses the system AEVS to verify eligibility and what is the username and password to log into this system ?
What is :
CA
Its amazing to have small talk on the phone with the member throughout your call we want to build that rapport with our members but we also need to know what is unacceptable small talk ;
What is :
Politics
Religion
Personal Finances
Gossip
Offensive jokes
Reminder : "It's okay to be Friendly just dont get invited to the wedding " Mr . Ro
What state are we able to speak with the parent or guardian even though the member is 18 without a consent , but if they are 19 we need to speak with the member or have consent on file to speak with parent or guardian ?
What is :
Washington
What are the Priority Steps for the Step of Ohio ?
What is :
Step 1 : Cold Transfer to State
Step 2 : Remind member Of Redetermination Date
Step 3 : Send Emailed Information
If you have to contact WHPF via phone , what is the code word you utilize ?
What is :
Mint
ProviderOne system is used to verify which states Eligibility ?
What is :
WA
What is the difference between hold vs mute ?
and
What State Hold time can not Exceed more then 30 seconds for the member and provider calls monthly ?
What is :
Mute : Allows you to remain on the line with the caller with no hold music with a disengaged microphone
- can be used for Processing ID Card , PCP Change , Reviewing Account , Sneezing or Coughing
Hold : Places the call on a hold and caller will hear music during that time
- Can be used for Calling the State
State of Ohio can not exceed more then 30 seconds monthly in holder time for member and provider calls
What 2 tabs can we review to view , authorizations , POA , PHI , Verbal Consents or Responsible Party ?
What is :
Alerts , Memos & Attributes
&
HEDIS / CONSENTS
What are the Priority Steps for the State of CA ?
What is :
Step 1 : Walkthrough Application
Step 2 : Warm Transfer to Local County Office
Step 3 : Send Emailed Information
Step 4 : Remind member Of Redetermination Date
Who should you communicate to when you are having tech issue on the phones or throughout your day ?
What is :
During Training : Trainer
After Training : Direct Supervisor
What two states would you need to create an Eligibility/ Enrollment case for to access the State Eligibility System ?
What is :
OH
NV
What is the difference between a Warm and A Cold Transfer ?
What is :
Warm Transfer : In a warm transfer, the new agent who receives the call is notified of the details, location and reason for the call. The member does not have to repeat the details when the new agent receives the call.
Cold Transfer : also called Blind Transfer, occurs when you transfer a call to another agent without first talking to them. The new representative to whom the call is attached may decide to answer or ignore the call.
You are calling out to complete a Redetermination call for Yakubu Umar Farouk , NY-PT72977F , but members Spouse Rauf Ayishatu answered and stated member is not around but you can speak with them , Are you able to speak with this person ?
Note : Use Production SF to pull up account
What is :
Yes a Authorization is on file valid from 7/19/2023 - 12/31/2078
What is the Priority Steps for the State Of WA ?
What is :
Step 1 : Complete Application on Members Behalf
Step 2 : Warm Transfer to WHPF
Step 3 : Send Emailed Information
Step 4 : Remind member Of Redetermination Date
True or False : If a member has a complaint or a grievance to file w should then open a compliant / grievance case ?
What is :
False
What is the Name of who we calling & Numbers we would call to verify eligibility for our Texas members ?
What is :
Maximus
After your call is over do you get wrap up time and if so how long ?
What is :
2 minutes