Show:
Disposition
Mandated Action Codes
Random questions
100

Bonus Question: What is the correct disposition if you left a message to the member?

Voicemail

100

What is the first mandated action code - if member enrolled with the plan/ cancelled/ did not enroll

Enrollment

100

True or False

Member does not have Transportation, are you still going to share the benefit?

True - if no benefit, offer CCHL 

200

The member requested to receive a callback at a specific date/time and callback time was scheduled prior to HIPAA validation and enrollment confirmation.

Callback Requested

200

What is the mandated action code re PCP 

PCP - appt declined by member

PCP - appt made

PCP - member had recent appt

PCP - upcoming appt

200

Member has a Simple HMO plan, is HRA required?

No - only for DSNP plan

300

The phone rang continuously (8 Rings) or “The caller is not accepting calls at this time”

No answer

300

What is the mandated action code re PCP - if it is correct or updated/changed or if they are on PPO plan - whether they are OON or pushback

PCP change/updated

PPO member - mbr seeing OON PCP

PPO member - PCP member pushback

400

Post HIPAA, enrollment is not confirmed and member declined speaking to us and is not interested in the campaign call after delivering call purpose.

Not Interested
400

What is the code to use in sharing benefits of the plan?

Benefits reviewed

500

The member refused to verify HIPAA 

Refused call

500

What is the last mandated action code that is required before closing the call?  

Member temp

500

What is the Marketing Misrepresentation process in accordance to the StarCare Retention page?

PORT Escalations: UPDATED as of 06/2024

Hey team, 

Please see the information below pertaining to the process for PORT escalations:

We will need to work the Marketing Misrep call driver as done previously, select that the member wants the transfer but select “NO”  for the transfer was not successful.  This will route to the offline team to reach out to the member within 1-2 business days.

Please include the following information in your ticket notes:

  •  Best Phone Number for Member: 
  • Type of Marketing Misrep:
  • Reason for Escalation:
  • Expected Outcome: 
  • OBV passed: 
  • LIS:
  • Sales Agent/Broker Name:
  • Sales Agent/Broker Phone Number:
  • Added Details of the Issue:


(This Template can be found under the Escalation Templates & Inportant  Documents folder)