Protocols
Per the Clean Desk Policy, you should do this with your computer before stepping away.
What is lock it?
This is the screen you will see when you first log into Workspaces.
What is the CTMS –Caller verification screen?
This type of listening should be used during provider calls.
What is active listening?
Name all the tabs found on the global banner in Workspaces. (There are 6 of them).
What is CTMS, Beneficiary, Claims, Provider Info, Prior Auth, Financial/AR?
This is the smallest country in the world by land area.
What is Vatican City?
This is the best method to use in Teams to send a quick, direct message to a coworker.
What is chat?
Representing your company as a united front and avoiding blame on other departments or colleagues is an example of this key principle of effective communication.
What is the Principle of Professional Boundaries?
This action is considered call avoidance in the Gainwell call center
What is a transferring call without a proper reason?
If an angry caller has a raised voice and is clearly upset, you should alter your tone in this way to respond to them.
What is using a calm, empathetic tone and acknowledging their frustration before offering help?
This country is known as the Land of the Rising Sun.
What is Japan?
This is data that can be used to identify an individual either directly or when combined with other information.
What is Personally Identifiable Information (PII)?
The state-of-the-art virtual agent designed to fulfill provider needs while delivering excellent customer service.
What is GABBY?
This is the maximum allowable average wait/mute time once a provider is speaking with you.
What is 120 seconds?
This causes a Gap Period for a DC Medicaid Beneficiary.
What is a delay in MCO enrollment?
This is the longest river in the world.
What is the Nile?
CEF stands for this, as it applies to the solution supplied by Gainwell.
What is Claims, Encounters, & Financials?
These are the Three P's of Healthcare.
What are Payer, Provider, and Patient?
This behavior during a call is unprofessional and not allowed.
What is eating or chewing gum while on a call?
The backbone of modern-day Medicaid.
What is EDI?
This European former capital, divided by the Bosphorus Strait, is the only city in the world to span two continents.
What is Istanbul?
A CSR for Provider Services would handle these three things from the list below:
-Billing inquiries
-Resolution with the provider
-Send complex cases to other teams
-Technology issues such as X12 transactions and web portal
What are:
Billing inquiries (such as denied claims and beneficiary eligibility)
Resolution with the provider (once specialty teams have completed the case)
Forwards complex cases (to Claims Resolution, Mailroom, or Finance Team)
This platform is used to manage all voice and digital customer interactions.
What is CXOne?
Provider enrollment activities for the District are completed by this vendor.
Who is Maximus?
If a provider wants to update their mailing address, they can do it by contacting this group.
Who is the provider enrollment broker Maximus?
1-844-218-9700 or www.dcpdms.com
This is the largest desert in the world.
What is the Antarctic Desert?