Service Transformation Medicaid Member Call Flow Procedure
Examples, including but not limited to, utilizing the caller's last name or their first name, ask how the caller's day is going, acknowledging the member/caller's birthday if approaching or just passed. Members calling in to advise they just had their baby, congratulate them, and ask how everyone is doing?
What is Building Rapport Examples?
Why is it important to document calls?
What is documentation is a crucial piece to call center Customer Service Advocates (CSAs). The goal is to have documentation that can help anyone who has access to the profile make sense of what transpired on the call.
How do you verify the identify of a foster care member's guardian or personal representative?
What is verify name matches the guardian or case head's in the system. Check with your sup for additional verification of 2 or 3 pieces of info.
True or False: Advocates do not need to read the disclaimers when advising about Value Added Services?
What is true?
Are templates required to be used on every call?
What is No, however, can be a useful tool for call efficiency and consistency.
Name the three policies for additional information?
What is
If member demographics show a yield sign, what should the advocate do next?
What is verify the information, and answer the questions that appear when you hover over the icon below.
What is the state requirement that you must do on all calls?
What is recap?
True or False: You would verify if we have documentation on file for the Estate of the Member or Executor and treat them as an authorized caller?
What is True?
True or False: Advocates must offer further assistance at the end of every call?
What is False?
(Advocate can offer this anytime during the call)
True or False: You should document any general information provided in the wrap up screen?
What is True?
What is Adult Protective Services (APS) callers required to verify?
What is member's full name and follow the same standards as the member verification process.
APS callers must provide the following information
Do we transfer termed members, members being transferred to another entity, members receiving general information, and members that speak a language other than English and Spanish to the After Call Survey?
What is No.
What is the order of Member HIPAA?
What is Medicaid ID, DOB and last 4 of SSN for member or Medicaid ID, DOB along with address and phone number.
Note: Name is not an identifier.
What is the process if a call is received from a staff member from another department who is requesting information or action on the member's account without an authorized caller on the line?
What is locate the staff member in Teams to verify their employment status. If you are unable to locate the staff member, advise the caller to call back with the member on the line.