QA Score Card
Where do you mark someone down for not sending QQ during an enrollment call?
Pre Enrollment
How much dead air is allowed per QA?
20 Seconds
How do you get an Exceeds on Setting Accurate Expectation when someone is calling in due to a move?
Congratulation's on your move. How exciting. Ill be more then happy to assist you with finding the best plan for you in the new area.
What is the correct Closing?
Thank you for calling Aetna. You can always call us Monday-Friday from 8am-8pm local time at (provide call back number)
How many pieces of information do you need to verify HIPAA
2
First and last name and one other piece of information
Where do you mark someone down for not reading SOA?
Acquired Scope of Appointment
How Often do you have to check back with the member when they are placed on hold?
90 Seconds
How many probing questions can get you an Exceeds in Probing question category for a MAPD call?
5 or more
How long after a call comes in do you have to start greeting?
10 seconds
What information are you needing to gather demographics?
Name
Phone number
Address
Member ID
Where do you mark down if someone does not read the Verbal Attestation?
Compliance
What are the minimum 4 probing questions you are required to ask on MAPD calls?
Budget/Premium
PCP
Medication
Pharmacy
How do you receive an Exceeds on Active Listening Skills category?
Respond to the callers comments( If they do not take any medications congratulate them on their health)
If they mention something personal acknowledge it
What is the correct Opening statement?
Thank you for calling Aetna. My name is (State your name) Licensed Agent. Who do i have the pleasure of speaking with.
What questions are you required to ask when gathering Medications?
Prescription Name
Type
How often is it taken
How often is it picked up
Where do you mark someone down for not asking Budget/Premium Question?
Coaching in Probing Questions and DNM in Pre Enrollment
Are you required to go over OON on PPO plan?
Yes
How do you receive an Exceeds on the Followed Logical Call Flow and Utilized Call Control category?
Agent Maintained control of the topics and call flow throughout the conversation even when member interrupts.
Agent not rushing or dismissive to the caller
What is the Correct way to transfer a member/caller?
Give member name of department and phone number you are transferring to.
Ask to place member on hold
Check back every 90 Seconds
When transferring Thank caller for holding and introduce
If member is not taking any medications are you still required to go over Prescription coverage?
Yes
Where do you mark someone down if they do not state they are a licensed agent?
Compliance
What are you required to go over during Plan Presentation on a MAPD call?
Plan Name
Plan Type
Plan ID
Monthly Premium
Deductible
PCP/Specialist Copay
Inpatient hospital
Dental/Hearing/Vision
Out of US Coverage
Prescription deductible/ Tier copays
Pharmacy network
Drug phases
How do you receive an Exceeds in the Handled the call in a Professional Manner Category?
Agent uses members last name throughout the call and treats caller like a VIP.
What is the Commitment Statement?
Ill be more then happy to assist you (state the reason they are calling) By doing that i will be asking you questions to identify your needs. Find the right solution and make sure we keep you protect. How does that sound?
What are the 3 Restrictions a medication could have?
Quantity Limit
Step Therapy
May need Prior Authorization