QA
How long do you have to refresh your hold with caller?
3 Minutes Max
TRUE OR FALSE
If member is calling to update income and you see a renewal in progress.
Just update income and ignore renewal in progress
FALSE
Always confirm in notices if there was a renewal notice sent out. If so you must complete renewal with member. You cant ignore anything in an account
If member is enrolled into OneCare, SCO, or PACE, who would they need to refer to for transportation?
They have to contact their plan for transportation requests.
SCO(Senior Care Options), PACE, or One Care(ICO)
True or False
Member wants info on HSN Transfer right away to Special Population
False
Need to go through HSN job aid, if after they still need more information then you can transfer
True or False
Can I skip application questions while completing application/renewal?
False
We must ask all questions in application while completing a renewal or new application.
*The only time we can skip questions is when completing a RAC and application opens to the beginning of application rather than specific section.
What is the max dead air time you can have on a call ?
30 seconds
How long does a member have to respond to a non-auto renewal ?
45 days
What coverage can the member have to be eligible for PT1 Services?
MassHealth Standard, CommonHealth,, and CarePlus
A CAC or Navigator is on the call, what extension would you transfer them to ?
MA_Assister Mainline
If you noticed in Verint you were 1 minute late to sign into five 9. What should you do to fix adherence?
Reach out to COL to advise you were late or was having a system issue
If you just submitted a application or renewal for a member, what information are you required to provide them?
Advise member of potiental coverage and any active RFIs
Member calls, aid category 06 and AA PAC. What are the next steps member needs to do ?
Complete HIX Application
TRUE OR FALSE
Any active MassHealth Provider can request PT1
TRUE
( Does not need to PCP, can be any provider that is active with MH)
True or False
Member needs to fix their name on file due to it being misspelled. I can just update in application
False
Need to transfer to MEC
Yes or No
Member has MSP questions about coverage, can I transfer to MSP unit?
No, Pull up MSP job aid on Knowledge Owl.
MSP unit cant determine eligibility or answer questions regarding MSP. They can only assist with payment issues with MSP.
How many pieces of information do you need to verify when someone is calling for someone else? (not HOH)
4 different pieces of information
True or False
Next renewal date on HIX dashboard is the date I tell the member
FALSE
Need to go eligibility and processes
If member needs to expedite their PT1, what can we do ?
We can only educate them to talk to provider and have them call the MH provider line.
( Member cant do anything, only provider)
Member received a letter stating assets are being held by MassHealth, which unit would you transfer them to ?
Estate Recovery/Third Party Recovery 1-800-754-1864
What program can you refer a medicare member to, when they dont have prescription coverage with Medicare and they are having issues with getting prescriptions
Linet Program
How would you verify an individual calling for an under 18 year old when they are alone in a HIX account?
You will need to find who signed the application (located in the application summary, that person can speak on behalf of the under 18 year old.)
When would you need to play consent audios to members?
Renewal, application or job update form
* Dont need to play for RACs
TRUE OR FALSE
Member has inactive coverage on MMIS, just completed renewal. If you are not HP trained, can you transfer to HP for enrollment ?
FALSE
Takes 24-48 hours for MMIS to receive updated information
If address on HIX is updated under address and in the application but in the dashboard address isnt updated. How can I fix this?
Need to enter application and mark member as account owner. Since it isnt marked that is why dashboard isnt updating