Refresher Training Skill Check | Baamboozle - Baamboozle

English 11 Public

Verification

Study Slideshow

Member(minor) mother calling to get pcp INN-What questions do you ask?

caller full name/ph#/mbrs full name/dob/nonpublic item/address/ph#/pcp+pcp location

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Mbr calls to check if their GHP account is active-agent adv acct active since 4.1.23- what should notes say?

MBR Called to confirm acct is active-verbally adv acct is active since 4.1.23

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Member provides a PCP name that does not match what we have in CSI- HOW DO YOU HANDLE?

ask member where/location they see the pcp - provide member with BOTH PCP NAME AND LOCATION on file-offer to update the pcp

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what is the last question on the new member welcome script?

Do you have any other questions regarding the plan that I can assist you with today? Please remember our number is on the back of your ID card. You can also

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What are the basic principles of Documentation

who called. what did they need. how was the need resolved??

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When verifying a caller you find they have an individual named in the address field indicating they are in the care of another person. The member is under 18 . Can they make changes-like a pcp change

YES THE INDIVIDUAL CAN MAKE CHANGES LIKE A PCP CHANGE

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WHAT SYSTEM CAN WE USE TO VERIFY WHY A RX IS REJECTING

DARWIN/PERFORM RX

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name 3 things you can do on the call to promote one call resolution

Take notes as caller speaks, provide options for member, recap what you did to resolve. allow your caller to speak,

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name a statement that should be used on every call- and why

assurance statement- acknowledges the callers issue- lets them know you are happy to assist

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name a tip to keep wrap up time low

ask caller to hold while you update account-use one note- recap the call

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what are the steps for a perfect call?

acknowledge- validate-recap need-Probe-resolve -recap-document resolution-satisfied?

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