Systems
What system would you begin and end a call with?
Maestro
Member calls in to change a PCP. What intent would you use to document the call?
Search and Assign Provider
Name 3 types of Macess Routes
Enrollment Route
COB Route
Member Materials Route
What is the call closing that is required at the end of your call?
"Are you satisfied with the service I provided today?" -NY
"It was a pleasure speaking with you today. Are you satisfied with the service I provided you today?" - PA
No required closing - OH
If a caller does not speak English, what tool would you use to service the call?
Language Line
What system is used to look up all standard operating procedures?
Knowledge Central (KC)
Member calls in to find a new PCP but their plan is no longer active. What intent would this call be documented under?
Eligibility status
Member calls in and you determine the account is no longer active. After checking the state system you determine the state shows the member should be active. What route would you submit?
Enrollment route-->Eligibility Discrepancy
How long should you keep a member on hold before checking back in with them?
2-3 minutes
If you are servicing a call that utilizes a TTY service for hearing and speech impaired callers, what is phrase you should use to indicate a completed statement to the translator?
"Go ahead"
Site members can access to find a copy on their member handbook.
DAILY DOUBLE!!!!
Eligibility Status-->Provided state Medicaid Information
Member calls in and requests an AR form be mailed to them. What route would you complete for this member?
Member Materials route
If your caller comes through unverified in Genesys, how many pieces of information must you gather to confirm and authenticate your member?
3 pieces of information -
Date of Birth / First & Last Name / Subscriber ID / Medicaid ID / Full Address on file / Phone Number on file (Follow your HIPAA SOP)
Where can members go to view their own claims, change phone numbers/emails, and view and download their virtual cards?
myuhc.com--> member profile (portal)
Main Phone System
Genesys
Member calls in to ask questions about scheduling transportation for an upcoming appointment. What intent and category would you use to document this call?
View Member Benefits--> Transportation
DAILY DOUBLE!!!!
Reach out to Supervisor in chat.
Transfer case in Maestro to Supervisor.
Transfer call to Supervisor.
Member calls in and reports that they are expecting a baby. Member wants to know if we can help with expenses/needs for her pregnancy? What would you offer to the member?
Healthy First Steps Program
System used to confirm questions on eligibility for a member. Not a UHC website.
MITS- OH
ePaces- NY
eCis- PA
What should be documented on the Wrap Up Screen?
Summary of the call details; review the ACD for accuracy before submitting.
What steps must you complete to save and submit a route before closing Macess?
Hit Floppy Disk
Hit F4 (Choo-Choo Train)
Copy SF #
Authorized Representatives have been permitted access to many aspects of a member's account. Name something that an AR is NOT able to do?
Make any changes on the member's account.
ie: PCP changes, Demographic changes, notification settings
Member calls in about an EOB that had a different DOS listed, than when she visited the provider's office. Is this an example of possible fraud?
YES. It is possible that the provider purposely adjusted the DOS to manipulate the insurance coverage for the billed services. Issue may need to be escalated.