🔐 HIPAA Hot Seat
What special identifier must brokers and sales agents provide?
What is their NPN or Agent ID?
Authorized Representatives require what two extra items besides standard HIPAA?
What are full name and relationship listed in Care Team?
True or False: In general, PHIs can help complete many NBAs.
What is True?
When introducing D2Me, what must the Guide correctly state about the visit format?
What is it is a 40-minute VIDEO visit with a Devoted Medical provider?
If you take time off, what system should you use to log it?
What is Meridian and then Workday?
Name 3 approved HIPAA identifiers that are not full name, DOB, address, phone number, and Member ID?
What are PCP, Medicare number, email, or agent of record?
For an unauthorized representative, what must you obtain from the member?
What is verbal consent to speak with the representative?
If an NBA begins shifting toward acting on behalf of the member or changing information, what should you do?
What is stop, educate the PHI, involve the member, or close as unable to complete if the member cannot join?
This high-impact detail should be stated early because members may decline if they think they’ll be charged.
What is the visit costs $0 / there is no cost to the member?
For unplanned time off, where can employees check available hours?
What is their 1x1 tracker?
It is compliant to provide this part of a birthday and ask the member for the rest.
What is the month or season of birth?
A member wants an additional passcode verification step. Where is this documented?
What is the HIPAA Verification Note text box in Notes tab?
A PHI calls to complete an Out of Area NBA. They confirm nothing changed. Later, they ask you to update the member’s address. What part can be completed and what part cannot?
Verification can be completed if no changes are needed, BUT address changes require speaking directly with the member.
A member objects because the visit is “too long.” What coaching approach should the Guide use?
What is connect the value of the visit to the member’s situation and explain what will be accomplished during the 40 minutes?
Being late to work, late returning from breaks/lunches, or late from BRB counts as this type of occurrence. Employees may have up to this many occurrences per month and still be considered on-track. Even if missed time is made up with manager approval, this still applies.
What is LTR (Late to Return), 3 occurrences per month, and it still counts as an occurrence even if the time is made up?
A member has both preferred first and preferred last names. Can you mix preferred and legal names during verification?
What is No — use either full preferred OR full legal name?
If you suspect the caller isn’t actually the member but they passed HIPAA, what should you ask for?
What is an additional identifier?
1. These NBA Flags are called care MOSR
What are D2mes and HRAs
What are the top two priorities for improving acceptance?
1. Correctly state D2Me is a video visit
2. Tie the visit’s value to the member’s situation / address objections
1. Ignoring Slack communication
2. failing to report an absence within 15 minutes, and
3. Not timely reporting/documenting tech issues can lead to three separate consequences. Name them.
What are a
1. verbal warning,
2. No Call No Show (written warning), and
3. The use of UPTO to cover time?
An outbound call begins. The guide says the member’s full name before verification, collects only one identifier, and discusses PHI. Name 2 compliance issues.
What are:
For provider office inbound calls with the member present, what representative information must be collected?
What are representative’s first name, provider/office name, provider's NPI, and callback number?
The Network Team clarified that retro PCP requests should only be submitted under 2 qualifying pathways. Name them and identify at least 2 approved access-to-care examples.
What are:
1. The member specifically requests the retro PCP change
2. There is a documented access to care issue
Examples include:
A Guide tells a member: “I see you have a $100 reward card for a video visit with a nurse at devoted. Are you interested in this? Identify what is wrong here and some important points the Guide did not mention
Failing to check and respond to important Slack communications through out the day can cause Guides to miss process changes or important updates, potentially impacting members and leading to what compliance and conduct consequences?
What are delays in care, member grievances, CTMs, and conduct action such as a VW?