Grievances
A complaint or dispute expressing dissatisfaction is known as a?
What is a grievance?
Hi, my name is ________, May I ask whom I am speaking with? I see that you have been authenticated through the system. Thank you. Is this the first time you have called us about this issue?"
What is fully CTI Validation?
What is Partially CTI Validation
What is Evidence of Coverage and benefits
What is your NPS Goal
What is your ACE Goal
What is your SCAD Goal
What is your Aux Goal
What is 81.80
94.5
93
2% or lower
These complaints are an example of?
Complaint about customer service?
Complaint about mail delay or ID card
What are examples of grievances
Provide an example of a greeting when the caller calls Allina Health Aetna
What is:Good Morning, thank you for calling Allina Health Aetna? Who am I speaking with
What is the first thing that is required when changing the member's address?
What is the MBI
How to request a copy of an EOB?
What is Use the quickbase, do not use send eob button
Article Number
000002576
Who can file a grievance
Member, authorized representative, or someone calling on the behalf of the member.
How many seconds to you have to greet the caller?
What is 10 seconds?
Who handles credit card payments for mail order
Who is SRT
In this example the provider is participating.
Look up the provider. Let the caller know they are participating. Offer the copy and offer to call the provider and make an appointment.
What is the timeframe for a grievance
They must file a grievance within 60 days of the incident resulting in dissatisfaction per the members EOC and CMS guidelines
What are the two things required in your professional call closing?
What is: Ask if anything else you can help with
Thank the caller by using a thank you statement
Where do you look for your verbatims?
Customer Feedback
Who must members use to get their eyewear reimbursed at the time of purchase.
What is EyeMed?
Provide the knowledge article for Grievances
Title and KA number is required for full points
What is Grievance: Part C Medicare Organization Determinations and Grievances Decision Tree
Article Number
000003109
What is required when placing a caller on hold?
Ask the caller in the form of a question to hold
Let the caller respond then provide a timeframe for the hold
Check in- if the caller is longer than the required time that you provided. When you return
thank the caller for holding
If you can share the AllinaHealth Wiki Tool, this will double your points
MSO Allina Health|Aetna Wiki Page - Home
If the member uses a provider that is not eyemed for their routine eye exam, how much will AllinaHealthAetna pay on that claim?
What is $50