Applying and Removing Admin Closures
What Admin Closure can be placed when a member wants to remove themselves from coverage?
Admin Closure 38 - Voluntary Withdrawal
(Applying and Removing Admin Closures Job Aid, Page 2)
What data points are needed to fully authenticate the Head of Household?
• First and last name
• Date of birth (including month, day, and year)
• The last 4 digits of the Social Security number
Note: The last 4 digits of the SSN are required if there is an SSN listed on the account. If the HOH and/or caller does not have an SSN listed on the account, the caller must be able to provide either the full address listed in HIX (including apartment number and zip code) or the correct Health Connector Subscriber ID. The full address or Health Connector Subscriber ID will only be used for authentication if there is no SSN listed on the account.
(How Agents and the Escalations Team Handle Warm Transfer Job Aid, Page 6)
What are the next steps for the Tier 1 agent after a HOH name change is completed?
The Tier 1 agent will complete the application with the member and play the appropriate legal skinny.
(Household Member Changes Job Aid, Page 4)
True or False: Agent do solicit, determine, and designate that a member does or does not have an Unmet Need.
False. Agents do not solicit, determine, or designate that a member does or does not have an Unmet Need.
(Unmet Needs Checklist, Page 1)
Who would be able to remove an Admin Closure 86?
MassHealth
(Applying and Removing Admin Closures Job Aid, Page 3, 4, 5)
The call disconnects during the process of the member being warm transferred. What are your next steps?
If the call gets disconnected during the warm transfer, the Escalation Agent will immediately attempt to reach out to the member.
(How Agents and the Escalations Team Handle Warm Transfer Job Aid, Page 8)
Which household member change requires that the HOH be warm transferred?
Changing HOH or Dependent SSN
Escalations:
• Confirm the HOH or member is on the call.
• Greet the HOH or member and obtain the SSN
• Verify the member’s name matches their Social Security card and complete the change
• Thank the HOH for providing the information, advise them that the changes have been made, and offer any additional assistance. If no further assistance is needed, end the call. The Tier 1 or Tier 2 agent will then complete the rest of the call with the HOH.
(Household Member Changes Job Aid, Page 6)
What is the definition of manual enrollment?
Manual enrollment is when a carrier enrolls a member on their side before the Health Connector can fix the enrollment and send the 834 file(s).
(Unmet Needs Checklist, Page 1)
What are the three ways to locate an Admin Closure in HIX?
Option 1: Check ‘New Alerts’ on the Account Dashboard. Clicking the “Notifications” link will populate what admin closure was placed on the account.
Option 2: Select ‘Administrative Closing History’ from the account dashboard menu. The list will contain all open and closed admin closures for the members currently on the account.
Option 3: In the member’s account dashboard, under ‘Latest Eligibilities’,
• Click ‘View All Eligibilities and Processes.’
• Click ‘View Details.’
• Choose ‘Medicaid Household Summary.’
• Scroll down to the members data section to locate the admin closure reason details.
(Applying and Removing Admin Closures Job Aid, Page 3, 4, 5)
True or False: A call summary must be provided even on agent-to-agent calls.
True. A call summary is to be provided on all calls, including agent-to-agent calls.
(How Agents and the Escalations Team Handle Warm Transfer Job Aid, Page 16)
What should an Escalations agent do if contacted to update a dependent's name or date of birth?
If you are contacted to update a dependent's name or date of birth, please complete the request and inform a supervisor or team lead. These updates are generally handled by Tier 1 and Tier 2 agents.
(Household Member Changes Job Aid, Page 1)
True or False: Carrier guidelines can be bypassed when handling a case designated as Unmet Need.
False. We must still work within carrier guidelines even if the case is designated as UMN.
(Unmet Needs Checklist, Page 1)
A member reaches out because there is an Admin Closure S7 that continues to re-appear on the account. What is the process to resolve this issue?
The member will need to contact the Social Security Administration to correct the issue. We can remove the Admin Closure S7, but it will return every data match and every re-submission of eligibility until the issue is resolved with the Social Security Administration.
(Applying and Removing Admin Closures Job Aid, Page 3)
When assisting a repeat contact, how long should the case remain open after 2 unsuccessful outreach attempts have been made?
The case will remain open for an additional 24 hours after two unsuccessful outreach attempts have been made.
(How Agents and the Escalations Team Handle Warm Transfer Job Aid, Page 15)
True or False: In HIX, the Head of Household can be changed to a different person.
False. The Head of Household cannot be changed to a different person.
(Household Member Changes Job Aid, Page 1)
If a member indicates that they are upset due to an Unmet Need, what must be selected on the Salesforce case?
The UMN Checkbox must be checked in Salesforce.
(How Agents and the Escalations Team Handle Warm Transfer Job Aid, Page 1)
Per the Job Aid, who would be able to remove an Admin Closure 38 that was placed by MassHealth?
Health Connector Escalations agents can assist with Admin Closures that were placed by MassHealth as long as they are in the list of Admin Closure codes that Escalations can apply or remove.
(Applying and Removing Admin Closures Job Aid, Page 1)
What additional information can be provided to an unauthorized caller that is or was previously was the sole subscriber on a plan?
If the caller is or was previously the sole subscriber on the account, the Escalations agent may share the caller’s individual premium as well as a 1095-A form, if requested.
(How Agents and the Escalations Team Handle Warm Transfer Job Aid, Page 15)
What happens in HIX when the updated name and DOB of a member matches that of someone who was previously on the application?
HIX will display a pop-up message alerting the agent that a person with the same name and DOB previously existed on the application. Agents will confirm whether this is the same person or that this is a new person to proceed.
(Household Member Changes Job Aid, Page 11, 12)
What criteria is used to confirm if a manual enrollment request is valid?
Examples of what you may need to review and fix on the outreach call with the member:
• Member’s current eligibility does not match the plan they are seeking to enroll into
• Member does not have an allowable reason, or the allowable reason is not included in the previous Agent’s Salesforce case notes.
• Member has not made full payment for their reinstatement.
(Unmet Needs Checklist, Page 1)