MTM 1
When you transfer an OTS to the pharmacist you should transfer the member directly to them?
What is False- Call the OTS line and warm transfer
If a Customer Service agent calls with a member on the ”back” line, you should just allow the agent to transfer the member to you?
What is FALSE-Get member information first to make sure they are a part of the HLP
If the member refuses to be recorded during the call, we should just continue the call. T or F
False- We cannot continue the call if they do not wish to be recorded
What number do you use to look up members in MTM Exchange? -Xcelys, COS and MDM?
What is Subscriber ID
When on the phone with a translator and the member, you can leave the member in the capable hands of the translator and move on to your next call.
What is False- Make sure you are transferring the member with the translator
What information do you need for your “Utilize Translator” activity note in MTM?
What is language, Translators name and ID number
When we ask the member about allergies to medication and reactions, where does this information go?
What is Past medical history
Which 3 apps would you need to have open and logged in to start your workday?
What is Jabber, Finesse, MTM Exhange
How much time do you have to research member information on an outbound dialer call?
What is 5 mins
You should never offer a review to member in an assisted living facility
What is False
When a member accepts a review, we never have to ask lifestyle questions if the review is scheduled for a later date?
What is False- Always ask lifestyle questions
What topics should be referred to Member Services from an incoming call?
What is Enrolling/Disenrolling in WellCare, Benefits coverage, Eligibility or ID cards, Address or PCP changes, Questions about OTC Benefit, Member Grievances, Member Claims Reimbursements, DME (Durable Medical Equipment) Issues – Requests for oxygen concentrators, nebulizers, wheelchairs, insulin/infusion pumps, orthotics, prosthetics, wound care, and ostomy supplies.
Where can you double check to ensure that a review has, in fact, been scheduled?
What is the History tab
Once we have the member on the phone, what is the first thing we tell the member?
What is " This call will be recorded for quality purposes any information provided will be strictly confidential"
If the member’s phone number is missing or invalid, where can we find a current phone number?
What is calling the provider or pharmacy
Other than the member, who can we speak to about the member’s personal health information(HIPAA)?
What is A5/A2 (authorized rep) or R5 (POA)
What app can you use to get updated information on a member’s phone number and/or address?
What is Xcely's
When leaving a message for a member it is okay to leave a member’s full name and DOB?
What is False- Only leave the member's full name
What app do you use to look up a member’s POA?
What is Xcely's
What app can you use to look up provider and pharmacy information as well as member claims?
what is COS
After how many attempted calls do we close out the member case?
What is 3
How many times can your attempts fail while signing into MTM Exchange before getting locked out of the app?
What is 3
When a call is disconnected for any reason, it is okay to continue the conversation on the call back without reverifying HIPAA?
What is No- ALWAYS HIPAA verify if the phone disconnects
Other than the member, who can decline a review for the member?
What is POA (R5)
What are some of the pieces of information we can use to verify HIPAA? And how many?
What is Member ID, Member's Full name, Member address, DOB. You will need 3 points of HIPAA