Issuer Tickets Basics
What is an issuer ticket?
A ticket created anytime there is a discrepancy with a customer account.
What must be done if a plan was canceled due to non-payment?
Re-enroll the customer into the same type of plan with a different policy ID.
What are the four levels of ticket priority?
Critical, High, Medium, Low.
What is the first step when working on an issuer ticket?
Format the ticket correctly.
What should be done if the carrier denies a reinstatement request?
Resolve the ticket and notify the customer.
Who can create issuer tickets?
The carrier, the agent of the customer, or the customer.
What should be verified for enrollment discrepancy tickets?
The enrollment status or subsidy amount with the carrier.
What should be done if a ticket has a low priority level?
Update the level to medium.
What should be included in the “Comments to Carrier”?
The status of the enrollment, subsidies, effective time frame, and any other relevant details.
What steps should be taken when a carrier requests a demographic correction?
Verify that the carrier’s information matches the system, ensure the information is correct in the application and enrollment, update the customer, and resolve the ticket.
What are some examples of discrepancies that might require an issuer ticket?
Nonpayment, carrier not seeing an active enrollment, subsidy amount issues, cancellation/termination, and demographic changes.
What should be done if the carrier requests an 834 file for discrepancies not found?
Send the latest transaction.
Which tickets should always be the main priority?
High and critical tickets.
What should you do if the carrier’s response indicates that an 834 file needs to be resent for a subsidy not found ticket?
Reach out to your lead or supervisor to send the file, comment back to the carrier that the 834 file has been sent, and reassign the ticket to the carrier workgroup.
Describe the process for handling a duplicate enrollment ticket.
Find both enrollments, confirm the customer listed, cancel the policy the carrier suggested, or confirm with the customer which enrollment to keep, then resolve the ticket.
Where can you find the tickets on a customer’s account?
In the ticket history tab.
What are the types of demographic corrections that might be needed?
Name correction, date of birth correction, gender correction, and address correction.
What is the typical priority level for most tickets?
Medium
What should be done when updating a customer about their ticket status?
Include the status of the ticket, any actions taken, and any next steps or resolutions.
Explain the procedure for resolving a reinstatement request ticket.
Determine if the carrier approves or denies the reinstatement. If approved, follow the EDI guide to reinstate or re-enroll the customer. If denied, resolve the ticket and notify the customer.
What is the goal when creating and resolving issuer tickets?
To have the system and the insurance carrier system match.
What are the three tabs under which issuer tickets can be found?
Insurer requested, issuer workgroup, and insurer returns.
Where can you view a ticket’s priority level?
Next to the priority as shown in the example.
How should you handle a ticket that has been classified as an insurer return?
View the carrier’s response, determine if the ticket can be resolved or if additional information is needed, update the customer, and resolve the ticket accordingly.
What should you do if the carrier requests a termination or cancellation of an enrollment?
Find the policy, select the appropriate action (cancel or change), provide the reason as stated by the carrier, submit, update the enrollment status, and resolve the ticket.