PHI
What is PHI?
Any medical information or individually identifiable information which alone or in combination with other publicly available information reveals the individuals identity. We want to only give minimal information to the caller in order to conduct business. This protects our members and their information.
What can be Viewed/processed in EC+?
•Delegate user rights to other Employer admins within their employer group and/or their POR
•Online Bill Pay
•Create custom census and billing reports
•Set up email notifications
What do you need to verify a broker?
Broker/agencies name
tax ID/producer #
call back #
What are the age restrictions for employee online enrollment?
under 16 and over 70
What are the 4 C's
CONNECT
CARE
CHAMPION
COMPLETE
Why is PHI important?
Our member’s privacy is our privilege
and responsibility to keep confidential.
What is required to register at EC+?
Group/account #
primary contact name
date of last bill
amount of last bill
What tab do we verify the broker under?
Commission arrangment
What is allotted time period for online enrollment?
90 days
What is the biggest communication problem?
We do not "listen" to understand
What is HIPPA?
•The Health Insurance Portability and Accountability Act (HIPAA) of 1996 is a federal law with provisions that affect health plans, employer groups, and individual members/subscribers.
What options are available under billing tab?
• Make a Payment
• Auto Payment
• Payment History
• Search Invoices
• Billing History
what customer type do you select for a group?
Sub Group
What are 3 functions that can not be performed online?
Enroll PT employees
Enrolling employees younger than 16 or older than 70
Enrollments outside of 90-day retroactive period
Cal-COBRA
Urgent ATC
Enroll court-ordered dependents without employee
Off-cycle specialty benefits additions/buy-ups
AFHC HMO Members
What is ownership?
Advocacy is the practice of taking OWNERSHIP of the customer’s issue and acting as a CHAMPION for the customer.
At least 4 examples of PHI.
•Date Of Birth
•Name
•Personal Physician information
•Dependent Info
•Social Security Number
•Medical Information
•Claim Information
What is required to reset password internally?
verify both security questions
What application and tab do you find the Plan code?
sub/fam
eligibility inquiry
What are 4 functions an admin can perform online?
Enroll new hires
Process OE changes (Member Level)
Manage qualifying events
Terminate eligibility
Change and update employee and dependent demographics
Change employee class or subgroup
Generate reports including census and transaction history
COBRA Manager
By taking ownership on the call what do you show?
you are showing our member you will resolve the issue.
By resolving the issue, we show we
CARE.
What are the primary DATA ELEMENTS for VERIFICATION?
Full name of the caller
The patients identity
Confirming their subscriber ID or SSN and then two of the three data elements listed in the table on page 4 match the information in our system
Date of Birth or Current Address
How long is a delegates access good for?
12 months
Walk me through the steps of locating the ID history?
customer service > sub/fam > action > ID card family > request
Walk me through adding a new employee.
For new enrollments without a SSN, the employer or broker will need to submit a paper application and follow existing process. Step
Action
1
Select the Employees tab on the Navigation bar.
2
Click the Add a new employee button.
3
Complete the personal information section by entering the employee data in the required fields.
Note: The required fields are identified by an asterisk. If a required field is left blank, the field displays in a bright color to remind the user to enter the information.
the "complete" portion of 4 C's demonstrates what?
recapping the actions you have taken, providing or outlining any next steps, and asking yourself and the customer if there is anything else.