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