Random Audits
We must confirm the blank and blank of both the member and person we are communicating with or it’s an Auto-Fail.
First and last name
We should be noting all cases we assist with. The case note must specifically state whether the case is being blank or blank
Accepted or Self-Directed
What is the break allowance per a 4 hour working shift?
15 minutes.
Most pending cases are accepted by us, when is it too far in progress?
Consultative exam completed.
What is the max allowed wrap up time?
5 minutes.
What is the maximum amount of time allowed to place someone on hold?
3 minutes
What should all bilingual/translation calls be logged as in LiveVox? Regardless of accepted or self-directed.
When we clock into Dayforce, we must be logged into our LiveVox phone system no later than...?
2 minutes. Your phone hours should match your timesheet.
What is the max age we will screen?
63 years old.
What script is used when we self direct a member?
Consultative talking points.
When we handle an incomplete screen and member would like to be called back later, what is the correct LiveVox term code to select?
Incomplete screen.
List 3 main doc types we must save to Documents after submitting an application.
Re-entry, Summary, Receipt, Overview, Confirmation page
If we do not provide consultative talking points to the member, we must change the close reason to?
Refuse consultative.
For children cases, who's income is not counted?
Grandparents, legal guardians.
Which health plan requires an OPT-IN form returned back before we can assist.
KAISER.
Call miner listens for important words/phrases that all specialists should use during calls for consistency. There are 6 total categories, name at least 4 of them
PHI Verify, Recorded Call, Politeness, Ownership, 3rd Party, Verbal Permission.
What needs to match on the Screening guide and the SSI application?
Treating source and medication quantity.
What is the passing score for our Quality audits?
92%
What is used to determine income eligibility?
Incoming deeming chart.
When we receive a warm transfer from a client HP, we must update the HP referral priority in compass summary to..?
Phone Referral.
On quality call audits, what happens when information not provided by the individual in entered into the application?
Auto-fail
What must be added to the application tab when a case is accepted or self-directed.
The screening guide score.
What are the 4 minimum requirements that SOS must fulfill before being eligible to bonus?
4.00 Accept Average, 92% Quality Audit, 75% Good Decision, 90% attendance
What 2 things must we verify to determine if we can start an appeal?
Appeal priority.
Was is a medical or technical denial?
What are the 4 scorecard goals? (Bonus criteria)
Lives impacted (Accepts)
Approvals (or Good Decisions)
Quality Audits
Schedule Adherence