Process Task
How do you process when the payer is closed?
Payer not reachable
What task note do you use when provided information to contact separate department?
Plan administered by (TPA Name/Separate Department); contact: XXXXXXXXXX.
When an Agent can not provide Buy and Bill information, who do we escalate to?
Supervisor
Whose national animal is the unicorn?
Scotland
Agent asks are you calling from the providers office? What is your response?
"I'm calling from Genentech Access Solutions at the request of the provider with first name ____ and last name _____ "
When an agent provides a different departments phone number and can not transfer the call, how do you process?
Change phone number
What task note do you use when the MG/PA department will not speak with a third party?
Prior authorization department will not speak to third parties.
If an Agent can not answer PA requirements after escalation to Medical Group, what do we do?
Input: PA as required.
Submit the last MG attempt with the main benefits call for completion.
What is the most common skittles color?
Yellow is the most common color of Skittles.
Driving IVR's: What is the correct format to enter the DOB for the member under the plan EmblemHealth?
Enter Month and Year only of Patient’s DOB
When an agent refuses to speak to Eva, how do you process?
Payer won't speak to Eva.
What task note do you use if the MG/PA department is unable to answer if step Therapy is required?
Payer unable to provide step therapy information after escalation.
TEAM NOTES!!!
What male artist has the most streams on Spotify?
Drake
Driving IVR's: For UMR, What 6 digit codes should you enter to get through IVR?
Enter 786998on keypad
OR enter any random 6 digit code to get to an agent
When an Agent is providing conflicting information, how do we process this task?
Post in QA chat for lead approval to submit for unreliable agent.
What task note do you use when an Agent will not provide cost share for the Jcode? ( Humana only)
Representative could not provide detailed benefit information.
What do you do if a call needs an escalation to the PA department and the Agent states that they are part of the prior authorization department.
Follow the graceful exit process and verify prior authorization information with another agent.
Taylor Swift's favorite color?
Red
Agent asks you to stop recording the call, and we are transferred to a new agent after stopping recording. What do we do next?
We must turn the recording back on for the new agent.
Prompt:
I need to let you know that the call is being recorded for quality and training purposes.
Agent unable to locate member using their ID, name and DOB. (BCBS call) What number must be called before failing the task?
Blue Line (8006762583)
What task note do you use when the plan has multiple tiers and cannot determine which tier applies?
Plan has multiple tiers. $X/$X/$X for the product, $X/$X/$X for the administration, $X/$X/$X for the specialist office visit.
After escalating to the PA department the agent states they cannot disclose plan specific information. What do we do?
Pushback, Are you able to provide general requirements for code(s) ____?
What state has the most bears?
Alaska
Medicaid Plan: In Plan Design, what questions can be skipped?
No need to ask family deductible, individual OOP, or family OOP. These can all be skipped for Medicaid plans ONLY.