Enrollment Broker
Where, in Health Track, would you locate items mailed or emailed by a participant?
and
Where, in Health Track, would you locate items mailed from MHD/AHS to the participant?
Documents are sent to us from the participants.
Letters are sent from MHD/AHS to the participants.
True/False Create a Research Task, is to only be submitted with supervisor approval?
True
If a participant calls in to report they did not receive their most recent blind pension check, what is the agents next step?
"Refer" (Give them the number) them to the Blind Pension department, Listed in referrals
True/False: We take credit card payments, just not over the phone.
False, credit card payments have not been initiated yet.
True/False: Agents are allowed to mute participants?
False, Agent should NOT put agents on MUTE
For Just Cause Transfer, does the participant get to select from the Just Cause Transfer option list?
No, the agent should choose based on the participants response
True/False: Agents can send Participants Health Plan (Healthy Blue, United Health Care, and Home State Health) replacement cards through the Info request tool?
False, the agent should refer participants to their respected health plans
What is the only tool an Agent can use outside of Open Enrollment?
A HOH calls in because her child (CHIP LOC 2 participant) was denied coverage for a recent appointment. You review their account and see that the participant has not paid her invoices in over 60 days.
Why did the child not receive coverage?
Has the child been disenrolled from Mo HealthNet?
She lost coverage do to 60 days of nonpayment, as soon as she pays off her invoices, she can resume coverage. She has not lost eligibility (has not been disenrolled) due to the participant being in LOC 2
True/False: Five9 will notify the Agent which queue a call is coming from upon dial in
True, before the participant is connected the Agent will know if it is a Blind Pension, Enrollment Broker, or Premium Collections call via Five9 prompting.
True/False Show Me Healthy Kids participants can switch to any of the Managed Care Health Plans
False, they are only eligible for Show me Healthy Kids. Agents can show them available services within their plan or help them choose a doctor if they need assistance for a particular health concern.
If a Participant wants to file a complaint about customer service by an agent, what should the Agent on the call do next?
Submit a complaint using health track if it is customer service based
True/False. All Blind Pension Task MUST be cleared by the end of Open Enrollment
True! Each eligible participant is listed as a task. Those without Part D will be automatically enrolled in a plan (By AHS Agents) if the participant does not respond by the end of open enrollment. Participants with Part D but no benchmark plan will have the option to choose a benchmark plan but not required. Their task will close without a benchmark plan selection.
Michael B. (AF29875327) calls in to submit his payment. What PO Box # would the agent give this participant.
Bonus: What are the other options an Agent can give her?
808001
Automatic Withdrawal
How long are agents allowed to put Participants on hold?
2 minutes
What is the website Agents will use to assist participants with Choice Counseling?
Bonus: What two tools will you use on this website (Double the points)
My Mo HealthNet Portal
Health Plans Comparison Chart and the Provider Search
What is the difference between grievance and appeals?
Grievances - Are complaints about the health plan (Refer participant to their Health Plans Grievance line)
Appeals - Are request by participants to overturn a decision made on a previous grievance/complaint (Refer participants to their Health Plans Appeals line)
Outside of Health Track, what other systems or websites will an Agent use during Open Enrollment ONLY?
A participant requests their premium be reduced. What are the agent's next step?
Create a research task with supervisor approval.
When on the phone with a participant, What is the chain of command for finding a correct answer? (Essentially where or who should lean on for support and in what order?)
1st - MO Knowledge Base
2nd - Knowledge Owl Support
3rd - Team Lead
4th - Supervisor
Name Each Enrollment Tool and its purpose.
HRA - Health Risk Assessment - Used for providers to adequately manage the care of each participant individually.
TPL - Third Party Liability -To update private insurance so billing is accurate.
JCT - Just Cause Transfer - Used to request a plan change during a participants lock-in period, due to acceptable reasoning.
PCP - Primary Care Physician - Used to select a primary care physician (required to have on file)
Health Plan Change/Opt-In - Used to change participants health plan during open enrollment.
Opt-Out - Used for participants to Opt-Out of Managed Care
Disenrollment - Used for both participants to request disenrollment from Medicaid/Mo HealthNet and MHD to send as a task for completion.
True or False? Notes and encounter actions are not required as long as call actions are completed during encounters.
False, Notes and Call Actions are required for every encounter.
What information can be obtained from the MMIS screen/excel work-around?
Participant Eligibility dates for Blind Pension
TPL information
Part D - Prescription Drug Coverage
Where do agents go to review Invoices?
Bonus: Where do Agents go, in Health Track to send duplicate invoices?
A/R Dashboard
Info Request
If an agents shift begins at 9:30am, what time should they be in their seat, in ready status on Five9 to begin taking calls.
Bonus - What is the morning procedure? (Think back to "Day in the Life of a CSR")
9:30am!! Coffee and other like things she be prepared prior to the start of an agents shift
Upon Arrival
1st - Clock into ADP
2nd - Log into Verint to review the schedule for the day.
**If time is allotted, Review Email for any updates
3rd - Log into Five9 and select "Ready" Status