How do you verify a members PCP per DHS requirments ?
Ask the member who is your PCP ?where do you See that PCP at? If they cant provide BOTH - You must provide both to the member
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How many validation questions are we required to ask a member?
6-
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When emailing member material what must you put in the subject line ?
e-secure
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Where do you assign the issue when the member provides their new address or phone #
Enrollment
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Grandmother is calling for member her adult grandson. She is on her way to the pharmacy to pick up his RX she wants to know when the RX was filled- Can you assist?
NO - that is PHI
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What must you confirm when staff calls from Children and Youth?
first and last name - what office ? call back number - confirm the name is on the children and youth list
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banana
Go to last place!
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shark
Other team loses 20 points!
Okay!
gift
Win 25 points!
Okay!
thief
Give points!
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25
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Name one example of PHI?
medical charts/records, claims records, policy numbers, ssn #'s RXinfo pcp -any non public item
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How do you verify staff calling from providers offices ?
First name - last initial of caller- providers name/location- NPI -call back number
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A mom calls in to request an ID card sent for her 3 member kids - the kids accounts are linked so you don't need to verify each one. T or F
FALSE -!
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Mother of 15 year old member calls because she has questions about a bill for members therapist visit . Can you assist?
You need verbal permission from the member to discuss any behavioral heath claims
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During validation a member provides the non public element 12-22-23 as a DOS for where in CSI can you confirm that info?
Claims- Customer service tree
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what does the acronym HIPAA stand for?
Health Insurance Portability and Accountability Act