CCD
Where can you find previous documentation?
Communications
What screen and screen group would you use to find the responsible party?
Individual Non-Financial+ Relationship
How would you find member's responsible party?
Hot links- Display Members- Second Screen
What does PHI mean?
Protected Health Information
PG advised member's well visit is already scheduled for next month. How do you proceed with the call?
Call to confirm the appointment
Where would you find responsible party on CCD?
Contacts on Record
What screen and screen group would you use to check a member's eligibility with the plan?
Post Authorization+ Managed Care
How would you find member's PCP?
or
Hot Links- Display Members-Display History
Health Insurance Portability and Accountability Act of 1996
Member stated she will self-schedule member's dental cleaning and declined again even after rebutting. How should you proceed?
Advise you'd like to schedule a callback to confirm that appointment and update our records.
You see an alert for an upcoming SAR on CCD. Where would you find the renewal date on CCD?
What screen and screen group would you use to check PA 211 eligibility?
Case Non-financial + Household Individuals
How do you place a member on the do not call list?
Hot Links- Display Members- Member Profile
What 4 pieces of PHI need to be verified on all calls?
Name
DOB
Address
Phone Number
Calling to schedule well visit for a 19-year-old member, and his mother answers. When asked if the member was available, PG advised member is at work and she handles his routine care. How should you proceed?
Check to see if there is a PRD on file. If not, schedule a callback for whenever the member will be available and send a PRD form
How do you get to your drafts?
Switch to Contact Search and type in your username
What screen and screen group would you use to find renewals and SAR?
Budget Authorization + MA Budget Authorization
Where would you find member's alternate ID number on Profound?
Hot Links- Display Members- Click on Member Additional 2
How long does a verbal PRD last?
That 1 call
18+ year old member wants to give verbal permission for his mother to speak on his/her behalf. What should you have up, reading verbatim?
Verbal PRD Script located on CCD under resources
Where would you find the answer to the security question "Name a medication that you are currently taking."
Claims under "RX"
PG cannot verify the phone number on CCD but advised she just updated it with the county assistance office. Where would you go to find the updated phone number?
Standalone
How do you view and clear your callbacks?
Maintain Cut Worklist click on your callback and change the O (for open) to C for (close)
Member verified all 4 pieces of PHI and requested to have her number updated. What do you have to do to update the phone number?
Ask 2 additional security questions
What should you always ask the member before dialing out to schedule an appointment?
Dates/times that work best for scheduling