You have VERIFIED Member has a PHI Form on file for the person you are speaking with, the Caller wants to change Members PCP , CAN YOU?
NO.. Only POA or Member may change PCP on an account
15
IN HEALTH INSURANCE WORLD A "COMPLAINT" is known as what??
GRIEVANCE
15
IN HEALTH INSURANCE WORLD A DENIAL EQUALS WHAT?
APPEAL
15
If its NOT DOCUMENTED it________ __________!
DIDNT HAPPEN!
15
You are making an outbound call and the member is unreachable you DOCUMENT, and close the case.
FALSE
15
Consider the following greeting did this agent nail his opening? HI ! This is ANDY Calling from Molina Health Care of TEXAS may I speak to CLINTON BIXBY?
Only ask for your Member by their FIRST NAME. Full names are PHI.
15
You ask your member if they mind taking a few minutes to complete a brief HEALTH RISK ASSESSMENT and they say sure,but I dont have time . Is there somewhere else I can complete it?
MYMOLINA self service member portal
15
Your member confirms that her PCP we have on file is correct. What is your next question to her ?
Have you had an opportunity to make an appointment to see your routine care provider?
15
Molina Health Care Transportation Department provide rides to active Medicaid members for PCP appointments
FALSE
15
MEDCAID MEMBER has just moved to a new address she needs to report this to ________
state welfare office
15
VISION BENEFITS are included for TEXAS MEDICAID members. TRUE/FALSE
TRUE
15
A member asks " Will I receive ID Cards for my dependents ?
YES Molina Medicaid of TX issues ID cards for Each Member on Plan
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Does my MEDICAID ID card have my PCP name listed on it?
YES!
15
Name 3 reasons we make WELCOME CALLS
Explain plan benefits*Make sure members know their PCP*Make sure welcome kit has been received. Help members pick a PCP, Offer to make PCP appointments
15
Following the Caller Verification Grid you realize the member you are calling about is a minor. What do you do
This is < Representative’s First name> from Molina Healthcare. May I please speak to [the parent or guardian of] <Member First name>?
15
Your member agrees to do the member material survey. Where do you document their responses to the survey questions?