Disposition
Bonus question.
What disposition will you use if the vm is full/not set up?
What is the correct process if you have system issues?
1. Put in the chat and let your leadership be aware
2. Save a screenshot with full screen and time on your desktop
3. Send an email with the proper template
How many call drivers are we going to use if we share the benefits of the plan?
Depends on the benefits that was shared
True or False - are you able to provide the card balance for the spendable?
True
What status do you use in Genesys for scheduled breaks?
Break
What disposition should be used, now that we are using Genesys - for members who are already termed?
Not attempted
What are the HIPAA verifiers?
Outbound Interactions – Two verifiers needed
The agent confirms that we are speaking with the correct person (this does not count as a verifier)
Member must verify two identifiers from the below list
Date of birth (Most commonly used)
Complete Address
Date of Coverage
Please not that partial verification is allowed per Central Point. Please see the article titled 'Verification for Outbound Calls'.
Inbound Interactions – Two or three verifiers needed
Agent obtains member ID to search account (this allowed but no longer counts as 1 verifier)
Member must verify two or three identifiers from the below list
Date of birth (Most commonly used)
Complete Address
Date of Coverage or Name of Plan
Phone Number
What call driver should you use if mbr is inquiring about an authorization status?
Auth filing and status
Can spendable cards be used out of the country?
No
What status will you use for "be right back"
Away
Using genesys, what disposition should we use for telco/tri-tone?
Disconnected call
What is the difference between disenrollment and cancellation?
Disenrollment is when the mbr is already active. Cancellation is when a request is made and mbr is not yet effective with the plan.
What call driver should we use if a mbr is needing to look for specialists?
PCP change
True or False
Reimbursement is available for spendable card benefit
The Wellcare Spendables Card does not offer direct member reimbursement options.
NOTE: Members who purchase items out of pocket due to not having their Spendables card, can return the items to the retail store for a refund (according to the store's return policy) and repurchase their item with their Spendables card.
Meal
None, we are not supposed to use this disposition?
What is the correct documentation for marketing misrepresentation in cc? including the call driver that you should use?
Call Driver: Other
Top Level Reason Code: Grievances
2nd Level Reason Code: Marketing Misrepresentation, MKTMIS
Action Item: PORTMM. Port Market Misrep
Issue Notes:
Member ID:
Member Name:
Best Phone Number for Member: (please do not advise a specific callback time)
Type of Marketing Misrep: (Enrolled w/o Consent, Benefit Misinformation, Provider Network, etc.)
Reason for Escalation:
Expected Outcome:
OBV passed:
LIS:
Sales Agent/Broker Name:
Sales Agent/Broker Phone Number:
Added Details of the Issue:
What call driver are we going to use, if the member wants to speak to her/his care manager?
Care Management
What is the website for the spendable benefit?
healthybenefitsplus
What status will you use for manual dial?
Busy and select manual dial
What is the correct disposition when a member verified HIPAA and declined welcome call?
Not interested
What is the correct process in ghost calls?
CSA.
Process:
What call driver should be used when the caller has moved to a new plan area, wants another Wellcare plan or to escalate an issue for any plan error due to data entry?
Plan change
What is the process of ordering a spendable card for the mbr?
Go to psp portal, enter the mbr id#, click the update card of the mbr, verify the add and choose the appropriate reason as needed, and advise mbr on the eta of the card.
What status in Genesys will you use if you have equipment/system issues?
Training