Q.A. HOT TOPICS

Select all that apply. What three (3) pieces are acceptable to verify HIPAA?

Name, Member ID, Date of Birth

Name, Address, Date of Birth

Address, Phone, Social Security Number

First Name, Member ID, Date of Birth

Name, Address, Phone Number, Date of Birth

Select all that apply. Name three (3) factors that MUST be verified on EVERY call.

What does "No HRA" mean?

No Health Risk Assessment on file

No Health Risk Assessment needed

No Health Readiness Assessment

None of the above

Select all that apply. Which is the correct demonstration of willingness to assist?

"Sure! Let me see....."

"Most definitely! I can absolutely check on that payment for you."

"Absolutely!"

"Sure, I'd be happy to look into that for you."

None of the above

True or False. All calls should be answered within three (3) seconds.

True

False

What are the components of the proper hold/transfer process?

"May , I place you on hold for 2 to 3 minutes while I....."

I need to place you on hold while I contact that department. It will take 3 to 4 minutes.

"I'll have to get you over to the claims department. Hold please....."

"Unfortunately, you've reached the billing department. Hold on....."

True or False. HIPAA fails are only reported to the compliance officer if they are reoccurring.

True

False

How do you correctly thank a caller and brand the call?

True or False. The agent should avoid 10 seconds of unexplained silence on the call.

True

False

When can a member skip verification?

The caller is upset or frustrated.

The caller mentions that s/he is pressed for time.

The caller is trying to talk to us while driving or is dealing with distractions in the background.

An emergency or crisis call.

All of the above.

None of the above.

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