Show:
Source of Truth/ System
ADH/Attendance
HIPAA
100

What ways can a rep locate cases? (Demonstration)

Cases tab- all agent cases listed

Cases tab- search top center

Home- Today's task - drop down for preferred search (Today, My Tasks, All Overdue, Completed within the last 7 days, Delegated Task)

100

Rep is requesting in 2 weeks to work an additional 2 hours on Monday and come in late on Thursday. What type of request is this and how should it be requested?

What is a flex request and email to leader. 

100

What 3 pieces of information can be utilized for authentication in addition to the member's full name?

What is

  • The member ID number
  • The members date of birth, (month, day, and year)
  • The member's full home address
200

What system do you use to search for documents that have been submitted by member and how do you search? (Demonstration)

What is SDS and Resources- Document Query - enter search preferences  

200

What is the ADH goal and how long do agents have to submit exceptions?

What is 95% and one day 

200

How do you obtain verbal permission? SOT? (What should the subject be asked to confirm)

What is


    • “Please verify your name, date of birth, and address. Do you authorize me to speak with "caller" to review / research all aspects of your account?                              Surest HIPAA Verification and Release of Information Guide - Verbal Authorization to Release Information
300

Member is seeking help for son's Autism, what process should frontline agent follow? What is your source of truth?

What is connect member with Surest Clinical Advocacy 

  • Always warm transfer to 833-860-0333. Clinical Advocates are available Mon-Fri 9am - 5pm Central. If unavailable or out of hours, provide detailed notes on the case.


  • ACET:
    • Open a case
    • Case Type: "Issue Routed"
    • Case Sub-type: "Clinical Advocacy"
    • Case Category: "Clinical Support"
    • Write relevant comments, and submit
300

What counts as an occurrence, how long are they tracked and how many can lead to corrective action?


Any unplanned time equal to 4 hours or more, 6 month period and 4. 

300

Aetna is calling to confirm if a claim processed. May rep discuss information? What information if any can be discussed?

What is NO and COB related inquiry 

400

A family of 11 will receive how many id cards when requested? Will they all arrive together? What is the source of truth?

What is 6 cards (3 unique sent in a set of 2) and Surest ID Cards

400

Rep needs to leave for the day what options do the rep have?

What is check for FPP PTO, inquire on paid/unpaid VTO, or take time unplanned

400

Tiffany is calling for her 16 year old daughter to see what she had done at her last visit 3/15/2024. (Claim  shows daughter had STD testing and birth control consultation) May rep discuss details? What is SOT? 

What is NO and Surest HIPAA Verification and Release of Information Guide - Sensitive Services 

500

What source of truth and system is used for a Proof of coverage letter?  (Demonstration)

What is Surest Proof of Coverage and UHSS

500

Rep is taking 6 hours of unplanned time and plans to make up the max allowed. How much time can be made up and how should time be called in? (Rep has 12 hours of PTO and has not utilized makeup this pay period) 

What is 4 hours per pay period. 2 hours unplanned PTO and 4 hours unplanned unpaid

500

John is calling to confirm patient responsibility of $1000 is valid for deceased wife's claim 02/02/2024-2/05/2024 Methodist Hospital for an inpatient stay. (Caller provided all details) May rep discuss claim? What is the SOT? 

What is YES and
Surest HIPAA Verification and Release of Information Guide - Deceased member