Allowable reasons
A member may request reinstatement for a plan outside of the _____ reinstatement window.
35
How many days does tier 2 allow the member to make the reinstatement payment?
5 days
What job aid would t2 agents use to contact member in regards to reinstatement ?
Member Outreach Authentication Job Aid
How many different statuses will you see on a member's plan card?
The answer is ( five ) Plan card 300
What job aid should be referenced when needing to contact carrier?
Outbound Carrier Request
What are the Allowable reason for Reinstatement
Hospitalization
Natural Disaster
Technical error/HC error
Exceptional Circumstances
Homelessness/Domestic Violence or Spousal Abandonment
What tool should T2 agents use to determine reinstatement amount due?
Reinstatement Calculator
What does the agent need to document during the reinstatement process?
The plan that the member is requesting to reinstate · Whether request is within standing carrier guidelines; if not within carrier guidelines, the allowable reason (for requests outside of the 35-day window) · If carrier approval has been obtained (for requests outside of the 35-day window) · The total amount the member needs to pay to be reinstated.
Which 2 statuses would restrict member from making a payment via IVR?
Terminated / Delinquent
Where do you go in salesforce to submit a carrier exception request?
Go to the email tab in the case to send a carrier exception request to the correct carrier and fill out the form COMPLETELY
Next step Tier 2 Agent takes if outside of 35 day window.
Member must have allowable reason
W/in carrier guidelines/need carrier approval
What would be the best method to make reinstatement payment?
By Mail
What resources does the t2 agent need to pull up before outreach to member?
Outbound Member Outreach Authentication Script Job Aid
What is considered complex reinstatement ?
Member’s plan card billing status is “active”, but the member is seeking to void the current plan and reinstate a previous enrollment.
What are the Carrier TATs? Carrier’s Turnaround Time to respond to a carrier request?
1 to 5 business days:
-Urgent: 1 business day
-All others: up to 5 business days
What allowable reasons can be self-attested
Homelessness/Domestic Violence or Spousal Abandonment
Where can one view notices stating why a member was terminated and due date of payments for reinstatement?
Member Portal under notices
What steps are needed to fully authenticate the member during outreach?
First last name, DOB, SSN, ..if no SSN mailing address or Subscriber ID
What shows on plan card that tells an agent the member is with in the 35 day window?
Reinstatement eligible
Where do you go in Salesforce CRM as the first steps to routing a case to the carrier?
Navigate to the Details tab, go to carrier information. Locate the fields listed below and make the appropriate selection from the picklist, then click Save button.
Carrier:<Carrier Name> picklist
Carrier Request Type: <Carrier Request Type>picklist
What is the first steps to determine if the member is reinstatement eligible?
Review termination notice to confirm if resinstament eligible from coverage that has a start and end date
Member must have had an effectuated coverage span prior to reinstatements
What would the payment consist of for reinstatement to be processed?
The account balance owed plus the next upcoming months premium
If no member connection on first out reach what status should be selected in salesforce?
If the HOH is unable to speak at this time, then Set Member Outreach Follow-Up Task Reminder. Set the case status to “Waiting for Member”. Validate that the automated task reminder was set. follow up in 1 business day
Where can t2 agents find a plan card?
Member Portal
What should a Tier 2 agent do if the carrier has not responded after 5 business days?”
escalate to the appropriate Tier 2 Team Lead via Team Chat so the Supervisor can outreach to the carrier for an update