Referrals and Complaints
This is a ticket where the plan name is left blank
What is " System Limitation/ System Preventing Processing" (inactive account)
This is a type of authorization that last for the duration of the call
What is One- Time auth Rep
This is the scripting that is read when a consumer appears to be providing inaccurate responses to proceed through the application or obtain a different eligibility result
What is the Honesty Statement
If no account or existing contact is found for the caller when searching in Siebel, this is created
What is a Contact
This Fast Alert refers to the NYSOH online consumer application changes effective 05/08/2025
What is Marketplace Update R53.3 (May 20255)
This is a ticket created when a consumer needs a card to use their FFS benefits
What is " CBIC Referral/ CBIC Card Request" ( CBIC referral)
This is the process which the agent greets the call, verbally gathers some basic information to compare it to the information in Siebel by the IVR, then determines the reason for the call and determining who is calling.
What is Verification
These are questions that are read when an update (that requires us to go through the application) is made to a consumers account
What are LSC questions
This code is used when reviewing work related items such as Fast Alerts etc
What is Review of Work-Related Item code (Busy- Review of Work-Related Item code)
This Fast Alert refers to immigration clock due dates for EP, APTC/ CSR, and Full- Pay QHP- eligible
What is Immigration Clock Shortened for Some Consumers (ALT1892)
This is a ticket created when a consumer submits a TPHI Termination letter
What is " TPHI/ MA"
This is the second part of determining the direction of the call (after verification and deciding if the caller's question requires access to account or case- specific information)
What is Authentication
This is the chart we use to process through an application when a consumer is discontinuing Health Care Coverage for the entire household.
What is the "Default Answers Chart "
This note type is used when transferring to ARU for any reason
What is Appeal
This Fast Alert refers to text messages sent to consumers who are required to provide documentation on their accounts but have not yet responded
What is Text Message to Consumers Requiring Documentation (ALT1891)
This ticket is created when a consumer never had the TPHI or cannot obtain a termination latter from the insurance company
What is " TPHI/ Termed TPHI"
What is " Non- Associated Assistor"
This is when the Marketplace systematically determines a consumers eligibility for the upcoming year.
What is an Administrative Renewal
This note type is used after submitting an incident
What is Complaint Incident Tracking
This Fast Alert refers to Medicaid eligible consumers that are restricted to one or more providers
What is Letter to Medicaid Restricted Consumers Fast Alert (ALT1759)
This ticket is created when a consumer is requesting an earlier end date for their QHP or EP due to overlapping coverage ( ie: ESI)
What is " Health Plan/ Other- Health Plan" (retroactive disenrollment ticket).
This type of marketplace caller can make updates for all household members
What is the Account holder
This is when a consumer calls in to the marketplace during a defined period to update their account and receive an eligibility decision
What is a Manual Renewal
This contact type is used when caller cannot or will not identify themselves to the CSS Agent
What is Anonymous
This Fast Alert refers to emails sent seeking volunteers to participate in focus groups to assist DOH.
What is Emails about Medicaid Consumers Focus Group Fast Alert (ALT1877)