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  • You are told by the person answering the phone that you have the wrong number , you leave call open
    FALSE
  • If its NOT DOCUMENTED it________ __________!
    DIDNT HAPPEN!
  • Molina Health Care Transportation Department provide rides to active Medicaid members for PCP appointments
    FALSE
  • You have left a message on the members voicemail you document salesforce and close call as completed as the member will now call back
    FALSE
  • 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
  • a member asks to be placed on the DO NOT CALL LIST you should leave call open to be reassigned.
    FALSE CLOSE AND DOCUMENT
  • 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
  • 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>? 
  • IN HEALTH INSURANCE WORLD A DENIAL EQUALS WHAT?
    APPEAL
  • UNDER WHAT TAB IN SALESFORCE CAN YOU VERIFY MEMBERS PCP ASSIGNMENT?
    HEALTH NOTES TAB
  • You are scheduling a PCP appointment for your member. Your documentation must include the_____ and ______.
    DATE and TIME of appointment.
  • WHAT STATE MUST YOU ASK MEMBER TO COMPLETE MEMBER MATERIAL SURVEY
    TEXAS
  • 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.
  • 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?
  • 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
  • Which case type do you select for the IL HRA survey in SALESFORCE
    RESPONDING TO MEMBER OUTREACH
  • A member asks " Will I receive ID Cards for my dependents ?
    YES Molina Medicaid of TX issues ID cards for Each Member on Plan
  • Molina Health care Medicaid members of TEXAS are auto enrolled every calendar year. TRUE/FALSE
    FALSE. You are required to renew your benefits every year
  • where do you find the questions for the member material survey
    member material survey tab in salesforce
  • You are making an outbound call and the member is unreachable you DOCUMENT, and close the case.
    FALSE
  • IN HEALTH INSURANCE WORLD A "COMPLAINT" is known as what??
    GRIEVANCE
  • VISION BENEFITS are included for TEXAS MEDICAID members. TRUE/FALSE
    TRUE
  • MEDCAID MEMBER has just moved to a new address she needs to report this to ________
    state welfare office
  • Does my MEDICAID ID card have my PCP name listed on it?
    YES!
  • Molina Health Care of TEXAS requires members to visit their PCP within __ days of signing up.
    90 days
  • Your member agrees to do the member material survey. Where do you document their responses to the survey questions?
    ‘Member Material Survey’ tab in SFL
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