VERIFICATION
What system do you use to verify a caller?
MMIS
What is our highest level of coverage?
MassHealth Standard
What system do we use to document calls?
Health Track
Which job aid would you use to help submit a task?
Escalation Task Templates Job aid
If a member would like to change their health plan, where would you transfer them?
MA_HealthPlan_Eng
How many pieces of info do you need to verify if the person is calling on behalf of someone else?
4/6
Who is eligible to enroll in a health plan?
Under 65, doesn't have other insurance, lives in community, and has MH Standard, Careplus, CommonHealth, and Family Assistance
What system would you use for a member with the agency affiliation SSA?
MA21
What job aid would you use if a member called regarding a bill?
Billing job aid
If a member with the AA of SSA needed to update their address, where would you transfer/refer them?
Social Security Administration (800) 772-1213
What are the steps to receive one time consent?
Verify info with HOH, ask permission to speak to/make changes with (blank), then you can speak to caller
What is the difference between a benefit plan vs health plan?
Benefit plan is what a member is eligible for through MH, ex. STD, CarePlus, etc. Health Plan is who the member receives their benefits from and is chosen by them, ex. Tufts Health Together, WellSense, etc.
What system would a CSR use to update a members address?
HIX
If you received an angry caller (hot call), which job aid would you use to assist?
If a member wanted to complete a PSI form over the phone, where would you transfer them?
343/MA_PSI_Eng TXFR
Can a CAC make changes to a members account?
No
If a member completes an application and is not eligible for MassHealth, they may be eligible for?
Health Connector
What system would you use to order a MH ID card?
MMIS
Which job aid would you pull up to see if a member receives a MH ID card?
Aid Category Matrix
If a member called to enroll in One Care, where would you transfer them?
MA_One Care_Eng
Where would you find the person authorized to speak to regarding a child in DCF Custody?
Address Field line
If a member has MassHealth CarePlus, is Early Intervention covered?
No
PMP Assignment History
Which job aid would you use for a member calling to withdraw their application?
Adding/Removing Administrative Closure Codes in HIX
If a member called and wants to file an appeal, where would you transfer them?
MA_EA Specialists_Eng