Call Opening
After obtaining the member’s id, you should obtain the following from the 1.0 agent?
What is The agent’s name
What is Who is calling
Whether hippa has been verified
The Members Date of birth is incorrect on the Members ID, What CD do you use?
What is the Member Demographic
In Central Point what article is to Help Identify Upset Members?
What is Recognizing Frustrated Callers
What are the main search categories you will use?
What are
Patient search goes through patient records
Client search goes through all available client records
Pharmacy search goes through all recorded pharmacies
which of the following can be used to filter records in the claims- patient summary panel?
What are claim type, claim status, drug name, date
If you received a call, you are to brand the call as this.
“Thank you for calling Member escalation my name is___”
Member Received misinformation.
What is Pay and educate
2 types of Concerns
What's Emotional, Transactional
What are the search types
what are
Name: First and last name, must also include DOB and or Zip code
Member’s phone number
Member id, will also display up to 10 previous membership ids that you’ve searched
hicn/rrb/beneficiary number, used for medicare part d
Rx number
Invoice #
Confirmation #: this is a system generated number used for refill
Client account number/alternate id number
Which of the following can you use to search for a drug
What are drug name, NDC#, GCN#
Who is the BEST MET
Who Is Jazmin
Member needs Case manager
What is other
Member Convinced their plan doesn’t care about them or their issue. Keep finding something wrong to see if you will fix it. Often interrupts, not great listeners and gets furious when resolution offered isn’t 100% what they wanted
What are Complainers
Where can you always find a members name, eligibility status, contact information and member id
What is PIP
Where can you find the coverage details like days supplies and copays listed for each of the coverage stages
Whats in the view all stages hyperlink
What are the dates for AEP?
when is 10/15-12/7
Member does not want to receive any Robo calls.
What is TCPA Revocation
You Barely had time to answer the call before caller demands to speak to supervisor
Who are Supervisor Seekers
When you first log into CSP you’ll be presented with search options
What is patient search, client search, pharmacy
What does it mean to add a pharmacy in the copayment summary?
Whats so your copayment summary will display actual costs at that pharmacy
What is the most common Calls MET will received?
What are Escalation calls?
request for Vacation Supply
RX/Pharmacy Inquiries
You can tell a member is Upset by these behaviors
What is
Raise in pitch/voice
Emphasizes each and every syllable
Condescending tone
Responds with short, brief answers or silence
Sighing
Passive aggressive sarcasm
In the CSP what does PIP mean
What is Persistent information panel
How many characters must be entered in a drug search slideout for csp’s type ahead logic to begin guessing the name
Whats 3