Accurate & Complete Resolution
How many days does it take for the Ucard replacement to arrive at the member's selected address?
The advocate should inform the member to allow up to 14 business days to receive the replacement UCard (not including weekends or holidays) SOT: Healthy Benefits Plus - Replacing UCard | KM1630482
Can the advocate discuss NBAs that are not currently appearing on the member's account?
Advocate cannot discuss NBAs that are not currently appearing on the member's account.
How many items are required to fully authenticate a member's account?
3 verification items. Full Name and DOB as the required items, then either one of the following: Member ID, Medicare ID or complete permanent address. SOT: KM1007709 HIPAA Caller Type - Member.
TRUE or FALSE:
The advocate should allow the caller to be the first to end the call.
False, the advocate should release the call after it ended.
True or False: It is not necessary to review and edit the intent summary when using the ACD.
False - Documentation in all intents must be reviewed for accuracy and completeness for ACD due to regulatory requirements, litigation, and CMS audit risk. Always review documentation and edit the intent summary to ensure all information is captured correctly, specifically caller names, member name, provider names, telephone numbers, spelling. SOT: KM1818752 Auto Call Documentation.
Who can activate, place orders (use OTC, UCard etc. benefits) or utilize OTC benefits to make utility payments on behalf of the member without the member's consent?
POA Guardian Conservator
True or False:
The advocate should disposition the member's NBA NBA intent without discussing it to the member.
False. If for any reason an NBA is started and is unable to be completed fully the NBA should be canceled. Advocates should document that the NBA was started but not finished as well as the reason why it was not completed (i.e member had to go; member verbally changed mind). Advocates should never complete an NBA intent without going through every part of the NBA script.
How do you identify internal callers from third party callers?
Internal Callers are considered an employee of UHG/UHC/Optum. Internal employees can be confirmed by looking up the caller in Outlook, Microsoft Teams, or the Sparq search engine. SOT: KM1005330 HIPAA Caller Type - Internal Caller. Third party examples are
What is the required closing spiel script under Greetings and Closing - Guidelines?
A standard closing spiel is - "Thank you for being the best part of our United Healthcare. SOT: Greetings and Closings - Guidelines, KM1006294
True or False: When doing a callback, it's not necessary to document the callback details using the Outbound Phone call type in Maestro.
False - All outbound member call backs must be documented using the appropriate Outbound Phone Call type in Maestro regardless of if the Schedule Commitment Callback intent is still open or if the interaction is still open. Documentation should include the phone number that was called, callback reason, if member is unreachable (document the reason). SOT: KM1837005 System Documentation - Outbound Calls
Will members receive a notification letter regarding the lapse in coverage?
Yes. Letters are sent to the member to confirm any lapse in creditable prescription drug coverage exceeding 63 days. SOT: LEP- FAQ
Should we discuss the member's NBA that doesn't requires a transfer to another area (e.g., Digital Preferences and Digital Registration) before we transfer the member to other department?
The advocates should discuss the member's NBA that doesn't requires a transfer to another area (e.g., Digital Preferences and Digital Registration). We do not present the remaining NBAs displayed in Maestro when both of the following are true: You present a NBA that requires a transfer to another area (e.g., Clinical NEC) and the member agrees to be transferred to the other department.
If the caller is calling on behalf of the agent/broker on file, how many verification items should you ask? And what are the required items?
4 verification items - Caller's Full Name and Agency Name as the required items, then any two of the following: Writing ID (Agent number), Party ID, TIN or NPN. SOT: KM1004106 HIPAA Caller Type - Broker/Agent.
For callers who have already completed HIPAA verification through the IVR system, what is the necessary script to follow?
"Thank you for verifying your information through our IVR system"
What is considered a complete documentation?
The documentation includes the Who (Caller's full name, relationship, and verbal consent), What (reason for call, advises to caller, and actions taken), and Where (called to, transfer reason and party transferred to, referred to). SOT: KM1836102 System Documentation - Standard Documentation Requirements.
Should the Good Cause Reinstatement be offered to a member during the course of a conversation if the member has not inquired about Good Cause reinstatement?
No. The ONLY time this information should be given is when it is prompted by the member, Guardian, Conservator, or POA.
Note: Refer to Good Cause Reinstatement for NPOP Members job aid. Good Cause Reinstatement is NOT an SEP.
The member mentioned that she is already done with her Annual Wellness Visit, what should be the correct disposition to the NBA intent?
Member already completed within the timeframe.
If you'll receive a Warm Transfer from an Internal caller, what will you do after the call was transferred and HIPAA has been verified by the caller?
The advocate must confirm the member's first and last name.
YES or NO: Is this the correct opening spiel for non HIPAA verified callers? "Thank you for calling United Healthcare. May I have your name, please?"
NO, advocate must include his/her name in the opening spiel. For example, "Thank you for calling UnitedHealthcare*. My name is <Your Name>.How may I <assist, help> you this <morning/ afternoon/ evening>?"
True or False: Based on Question #3, caller's information should be documented regardless of where they are calling from. So, it's important that we also document the internal caller information like their name, initials or MS id in any intent.
False - UHC employee name, initials, or MS ID in ANY intent: This includes any and all UHC employees and ancillary vendors Example: Optum, Housecalls, Navigators, Dental, Vision, Hearing, Offshore, etc. SOT: KM1836102 System Documentation - Standard Documentation Requirements.
When can I direct the member to call Mom's Meals?
When the member:
The Digital Preferences target MA members who have not opted in to paperless or text consent yet whereas, the Digital Registration encourages members to create an online account and utilize our online resources, especially our member portal and mobile app.
How do you obtain member's verbal permission for unauthorized individual?
The advocate must request to speak to the member and Obtain the member's:
YES or NO: After assisting the caller, if the inquiry necessitates a transfer to another party, is it still required for the advocate to provide final assistance before the transfer?
Yes, we still need to provide final assistance before we complete the transfer
True or False: It's important that call documentation should be completed within the day but is not necessary to complete it real time or at the end of each interaction.
False - Every call must be documented real time or at the end of each interaction. Document in every account opened in Maestro using the proper Intent(s) to match the caller's issue(s). Documentation is available for review in Maestro as soon as an intent is completed. SOT: KM1006283 System Documentation - Index.