Account wellness
What should I view when performing an Account Wellness Check?
Possible areas to view:
If I am unsure if speaking to AI or the member, what should I do?
Ask
Am I speaking to a live person?
Note: Allow the caller or bot to respond.
I am unable to continue the call without speaking to a live person. At this time, I will be disconnecting the call, please call us back when a live person is available.
What is considered exceptional performance for Average ACW?
5 seconds and under
Describe what a PBM is?
Refers to a business that helps to manage the drug benefit of a medical plan through various cost-containment efforts for different groups (employers, managed care organizations, health plans, unions, etc.)
What is the name of the pet dinosaur on the TV cartoon "The Flintstones"?
Dino
What is the Account Wellness Check?
Assists with first call resolution to ensure we have discussed all opportunities and needs with our caller.
Can we accept an Artificial Intelligence call to Authenticate a member?
No, make every attempt to get a live person on the call.
What is considered unacceptable performance for Average ACW?
50.01 seconds or more
What does MBR stand for?
Member
Whitney Houston went to the top of the music charts in 1992 with which Dolly Parton song?
"I Will Always Love You"
What should you always make sure is up to date when speaking with a member?
Verify phone and email address.
Are we allowed to speak to a live person initially then be transferred to provide information to AI?
No, we must always speak to a “Live” person when providing authentication, information or performing processes for our members.
What is the adherence to sign in goal for exceptional performance?
95% or higher
What is a client?
Clients are health insurers, Medicare Part D drug plans, and Employers.
What 1997 movie features Will Smith and Tommy Lee Jones as undercover secret agents who police extraterrestrials?
"Men in Black"
What should you do if another prescription is available to fill?
Offer to fill the other prescriptions. Refer to Prescription (Rx) Refill/Renewal (Order Placement-004628)
What happens if I am automatically transferred to AI upon answering the call?
Notify the caller that you cannot continue the call without a “Live” person on the call.
What is unacceptable performance for adherence sign in?
Below 80%
What W.I. provides a list with phone numbers for Dedicated and designated clients?
Content ID : CMS-PRD1-105547
Transferring Calls to Dedicated and Designated Client Teams
In one of the most popular Dr. Seuss books, what won't Sam-I-Am eat?
Green eggs and ham
What is the verbiage for recapping and closing the call?
Designated Client Closing: Refer to the CIF for verbiage, if applicable.
Example: Today you called in regarding the rejected claim for Vyvanse through the local CVS pharmacy. We discussed the medication requires a prior authorization to be covered & I submitted an EPA form to the doctor’s office for that. I advised once the form is received from the doctor’s office it would take 24-72 hours to be completed. You have enough medication on hand until the decision is made on the prior authorization.
Example: Is there anything else that I can assist you with today?
What should you do if you have concerns about whether your caller is AI or a “Live” person?
Reach out to your supervisor.
How can we improve member experience?
Call quality, FCR, Account wellness etc.
What is a DEP?
A person the member is responsible for. A dependent can be any of the following:
In a website browser address bar, what does “www” stand for?
World Wide Web