G&A Part II
G&A Part II Quiz
Test your knowledge on handling complaints and issues related to benefits with our engaging quiz! Whether you're a seasoned professional or just starting out, this quiz will help you understand the best practices for addressing caller dissatisfaction effectively.
Key Topics Covered:
- Complaints and resolutions
- Proper documentation practices
- Understanding grievances and appeals
- Pharmacy complaint procedures
Caller expressed dissatisfaction regarding their benefits and you resolved their issue. Would you check "Yes" for complaint?
No
Yes, unless the caller voluntarily states that they did not wish to logde a comlaint then you would not.
2. Do not ask callers if they would like to file a complaint, if they express dissatisfaction you are required to clearly notate the complaint and send to the correct area according to process. True or False?
True, unless the complaint is related to a process the required you to ask permission first (i.e. QAA Complaint)
False
Reconsideration, Disputing responsibility on a pharmacy or medical claim are all examples of?
Grievances
Appeals
Mentor document regarding Late Enrollment Penalty complaints?
Medicare COB Overview
LEP Dispute Call Guidance
Examples of when to follow the Pharmacy Complaint Calls Overview process
Pharmacy address or telephone information is incorrect in Humana system or the web.
My Rx was denied
Member complaint about a non-Humana Pharmacy mail order issue
Caller states Pharmacy speaks poorly of Humana
Caller states they would like their Rx reconsidered because it should be covered
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