Handbook
Call Script
Random Questions
Call Outcomes
"Ifs"
100
How Many Days Of No Call No Show Are Considered Work Abandonment ?
3 Days
100
What Should We Be Asking All Female Members 18 and older ?
apologize for having to ask but ...
* Are You Currently Pregnant ?
* Expected Due Date
* If They Have an Appt Scheduled w/ OBGYN
100
What Are 2 Forms Of Unacceptable Communication When Calling Out Of Work ?
Voicemails and Emails
100
When a Member States They Don't Have Time To Complete Survey
Examples * " I am at work " or " I am Driving "
Call Back
100
If Member is Away At College
What Should You Do ?
- Ask for another number.
- If not, you can mark as Left Message.
200
What Are Some HIPPA Violations ?
200
What Information Must We Get Before Beginning Call ?
Name , DOB , FULL Address (including zip code)
* if we aren't speaking to the member we are calling about we should be asking for the first name of the person who will be completing the survey as well.
200
After Getting PHI , What Do You Want To Adv The Member ?
Call Is Being Recorded For Training and Quality Purposes
200
No Dial Tone
No Answer
200
If the P/G states “I already completed the survey for my other children.”
Give 2 of the main responses you would adv them of
o Apologize for any inconvenience but advise the parent/guardian that survey must be completed per individual/child.
o Advise that it is a requirement for all medical insurance companies that provide coverage for Medical Assistance consumers.
o Advise parent/guardian that we will attempt 2 more times to complete survey, then mark as Call Back Later.
o If parent/guardian declines, mark as refused.
300
Which Holidays Are We Not Required To Work On ?
New Years’ Day
Memorial Day
Independence Day
Labor Day
Thanksgiving Day
Christmas Day
300
What Is The Correct Closing ?
Closing- Thank you for being a VAULED member____ of the
Geisinger Health Plan Family and for taking the time today to
complete the survey You have a great afternoon/one
300
How Many Surveys Should Be Completed Weekly ?
25 Surveys
300
CAO call
Wrong Number
300
If a mbr/Pg says " I didn't pick this insurance "
what do you as a rep adv?
- Advise the member that they have been auto enrolled into the GHP by DHS.
- Advise the member of their effective date.
- Advise that it is a requirement for all medical insurance companies that provide coverage for Medical Assistance consumers.
- Advised the member that they can complete survey now and contact DHS later to discuss other MCO options.
- Advise the member its to see if they qualify for any additional benefits based on their medical needs not offered by every plan and they can decide later if GHP is the best option for you.
400
What Is The Definition of Protected Health Information (PHI):
PHI refers to individually identifiable health information received by the company’s group health plans or received by a health care provider, health plan or health care clearinghouse that relates to the past or present health of an individual or to payment of health care claims. PHI information includes medical conditions, health status, claims experience, medical histories, physical examinations, genetic information and evidence of disability.
400
What Should We Be Saying Soon As The Call Is Answered ?
Hi this is Geisinger Health Plan Family calling
may I please speak to ________ (Under18-Parent or Guardian
of) __
Hi ____
again this is Geisinger Health plan family calling to welcome you to your new plan and we
also do a brief survey
would you have about 2min
so I can get this completed for you
400
If mbr 18 or older is unavailable , who are you allowed to speak with ?
( Care Of)
400
•Customer does not answer, or not available if speaking with someone who is unable to complete the survey
VoiceMail
400
After completing survey, If a mbr askes for Id # , what is your response ?
Contact the mbr service number on the back of your insurance card , they will further assist you.
500
In What Year Did Clark Resources Add Call Center Operations To Its List of Services ?
2009
500
Before Starting The Questions On The Survey , What Should We Be Saying Verbatim ?
Welcome to GHP Family. GHP Family is a managed care plan which works with the Pennsylvania Department of Human Services. You must choose a primary care physician from within our network. GHP Family also provides special services for members with specific conditions. These services help members get the care they need to manage their health. We can also provide you information regarding transportation and basic dental care. GHP Family will keep you informed about the available programs and let you know if you qualify.
****if you have any questions after this survey please contact the number on the back of your insurance card****
500
What are All The Performance Metrics ?
Quality Score - 95%
Success to Contact Rate - 50%
Contact Rate - 15% or less
Refusal Rate - 10% or less
120 dials daily
25 surveys a week
500
Give at least 3 reason why call outcome "disconnected" will be used
* Death
* imprisonment
* Chose another insurance plan
500
If Mbr Stated They Haven't Received Their Welcome Packet or Insurance Card , What Would You Advise?
* Adv Effective Date
* Id Cards Typically Take 10-14 days to arrive after that effective date