Show:
Maestro Intents
System Documentation
MOP
Employer Group
Verbal Grievances
100

This intent is used to update member preferences.

Update member profile intent

100

One-time authorization received to speak to 3rd part, requires what documentation in Maestro?

Name and relationship

Example: Member/POA gave one-time authorization to speak to <relationship> <John Doe>.

100

What are the members MOP options?

  • Recurring EFT
  • Recurring Credit Card
  • SSA/RRB
  • Online EFT or Credit Card Payment (through the plan website)
  • Annual Payment (MOP) options
100

Used to send/view Group plan materials

Group Fulfillment Portal

100

When the caller's complaint meets Verbal Grievance guidelines, advocates are not requires to submit a Verbal Grievance if the caller wishes not to.

True / False?

False.

When the caller's complaint meets Verbal Grievance guidelines, the Advocate MUST submit a Verbal Grievance regardless of whether the caller wishes to do so or if a grievance was previously filed.

200

This intent is used for Renew Rewards.

General

200

All providers searched must be documented to include what?

  • Provider's first and last name
  • Address and phone number
200

Name two systems where you can view members current MOP?

Maestro, GPS, Marx

200

We utilize this to find a document we refer to as an Underwriting Approval Form. None as source of truth for EG members

Employer Group GRIF

200

This resource can be used to categorize grievances.

Compliance Accuracy Tool in KC.

300

What category (intent) would you select when a member is past due and would like to get caught up on payments?

Billing - Repayment Plan

300

If placing outbound calls to a pharmacy or Optum, what must be documented?

  • Pharmacy name 
  • Phone number dialed
  • Outcome of the conversation
300

Once the SSA method of payment is set up or cancelled, how long does it take for the change to reflect on the members SSA check?

90 Calendar days.

300

This contains a list of names Employer Groups, Unions, or Third- Party Administrators offering our products may be referenced as.....

Group Retiree Sharepoint

300

This is used to provide descriptions of complaint types?

Complaints, Appeals and Grievance Glossary

400

What intent do we (NEC/ET agents) have to select on every call?

General - Escalation Team

400

What must be documented in Maestro for calls regarding claim inquiries/details?

  • Claim number(s) or UFE number(s)
  • Provider name(s) and Tax Identification Number (TIN)
  • Date(s) of Service (DOS)
  • Billed amount (if applicable)
400

For a member with the Online Bank Payments MOP, how would the members MOP display in our system?

Billing Statement.

400

The purpose of this job aid is to assist Employer Group Advocates with information related to Employer Group call types (talks about 800 series; Endorsed; NPPO; Subsidized)

Employer Groups- Index

400

For fulfillment requests (such as ID cards or OTC catalogs) that a member made with Customer Service two (2) or more times previously, but the member never received the item. What complaint reason does this fall under?

Customer Service

500

As a tier 1 Advocate how do you document a Provider Services call?

Misdirected Call

500

The system auto- documents calls about what? (Hint: there are only 4)

* Claims

* Provider

* Benefits

* Eligibility

500

Members wanting to make changes (edit or cancel) to their automatic payments made online, will need to be set up before when?

The 23rd of the month. Any changes made on or after the 23rd will not be effective until the second following month.



500

What job aid provides the suggested script if an Employer Group does not allow member updates?

High Profile Employer Groups- Index

500

For a termed member, when can a VG be filed?

Grievances only for things that occurred while they were active in the plan