Welcome Call Knowledge Check

HIPAA Verification

100

Unauthorized Parties - True or False

HIPAA verification does not have to be obtained by the member before the unauthorized can be given permission to speak on their behalf.

False

HIPAA verification must be obtained by the member before the unauthorized before can be given permission to speak on their behalf.

200

Outbound Calls

After confirming the members full name as it appears in the system, what other additional verifiers are required?

- Date of birth

- Address

- Health Plan / Product ID

300

What are examples of the Health Plan / Product ID?

- Member ID

- MBI

- HIOS ID (Health Insurance Oversight System)

- CIN (Client Identification Number)

400

Authorized Representative (Outbound)

When the caller's name matches the information in the system...how many pieces of information must we verify?

2

500

Inbound Calls

How many verifiers must we obtain once we confirm that we are speaking with the correct person?

2

• Date of birth
• Health Plan / Product ID

• In absence of Health Plan / Product ID we can validate one of the following as a last resort
  • Address and Phone Number

Disposition Decisions

100

Free Points

+100

200

What are the two dispositions that count as "successful" for Welcome Call?

1. Call Complete

2. Call Complete WC-ENR/PRV/BEN

300

You verified HIPAA and the purpose of the call but did not address enrollment, PCP, and a benefit. Which Disposition?

Call Complete

400

True or False

When completing an Inbound Welcome Call, the agent will select

Call Complete Inbound

False

Inbound Customer Service call completed. This call was not related to the campaign. The member called back into our queue for questions.

500

You verified HIPAA and purpose, and you addressed enrollment, PCP and a benefit. Which disposition? 

Call Complete WC‑ENR/PRV/BEN

Action Codes

100

True or False: If you select any disposition other than Call Complete WC‑ENR/PRV/BEN, you must still choose at least four action codes.

False

Other dispositions have no minimum requirement, but you should select all applicable codes

200

What is the maximum number of action codes you can select for a Welcome Call?

Six action codes total.

300

Name three examples of Benefit-related action codes you might select during a Welcome Call

Examples Include:

• Dental Benefits Reviewed

• OTC Benefits Reviewed

• Vision Benefits Reviewed
  (Other options: Pharmacy Benefits Reviewed, Fitness Benefit Reviewed, etc.)

400

When using the disposition Call Complete WC‑ENR/PRV/BEN, what is the minimum number of action codes required?

4

500

What are the 4 required action codes required when dispositioning a call as :

Call Complete WC‑ENR/PRV/BEN

One Enrollment, one PCP, one Benefit, and one additional code of the agent’s choice.

True or False

100

Free Points

+100

200

It’s acceptable to present the English CSAT survey to a member on a translator call.

False

300

For ghost calls, agents should always try to let the caller hang up from their side after using the appropriate script.

True

400

We disposition the call as HUNG UP when the member hangs up the phone.

False

DO NOT SELECT 

We use Disconnected Call

500

 If HIPAA is verified and the call purpose is stated, you must always use WC‑ENR/PRV/BEN

False

Use WC‑ENR/PRV/BEN only when Enrollment, PCP, and Benefit components are completed; otherwise use Call Complete.