What system was upgraded over the weekend?
Enterprise
How many pieces of information need to be verified for a member?
Three
What does PRG stand for?
Plan Resource Guide
What are time exceptions?
They are activity codes and adjustments that are manually entered by agents to justify an aux code that was approved outside of the set schedule or adjusting a break/lunch that was unable to be taken due to a long call.
True or False: You must utilize the silent hold protocol on all calls and set the expectation anytime you are placing them on hold
True
True or False: Enterprise upgrades were applied to the provider and member call screens/profiles?
True
How many pieces of information need to be verified for a provider?
Two
1. Member Not Found
2. FAP Tool Doc
3. Friendly Feedback
Where do time exceptions get entered?
NICE
True or False: I can go to lunch and break early/late
False: You are required to take lunch and break as scheduled on NICE, unless you have prior approval from leadership, or you are unable to go due to a call.
Name the two new tabs that were added to Enterprise
1. Member Communication Preferences Tab
2. Member Enrollment History Tab
What identifiers can be used when verifying a member account?
Where is the member not found document located on the PRG?
Member Eligibility Process
True or False: Anything less than 5 minutes does not have a significant effect on adherence
True: Only submit an exception if you were in the activity code for 5+ minutes anything less than 5 minutes does not have a significant impact to your adherence, and it will be denied by WFM.
True or False: General Chat should only be used when you are on an active call
True: Any questions you have when not on a call can be answered in our chat.
What existing features in EP were upgraded?
1. Member and Provider HIPPA Verification
2.Member and Provider Follow - Ups
3. Provider Location
What identifiers can be used when verifying a provider?
Where is the appeals cheat sheet located at on the PRG?
General Documents-->Additional Resources-->Appeals Cheat Sheet
How long do you have to enter a time exception?
Up to 5 Days including weekends
True or False: Our hold time is 90 seconds when transferring a call and when the caller wants to place us on hold
True
What PHI identifier was added to the Member HIPAA Verification Screen
Members Phone Number
True Or False: Providing information to a provider about the member's active status before verifying three pieces of information is an automatic PHI fail.
True
Which reference document on the PRG gives information about member's being billed for the difference between the total cost of services being charged and the amount the insurance pays.
Balance Billing
True or False: When adding activities such as "Off the Phone" "Meeting" Etc. you must leave a comment
True: Leaving a comment is mandatory for all activities! If you were approved by leadership, you can put something along the lines of “Approved by (Leader’s initials) Approved by ER” or "Approved by Ebonee".
What state are we required to use call back when needing to assist a member with an outreach to the office?
Louisiana
If you need to call the office to fully assist the member, do not place the caller on hold, Do not conference the member on that call.
Instead, you are to offer the member a callback and call the office in Aux 8 (callbacks) immediately after the call.