C3 New Hire-CARE, HIPAA, Call Mgmt, ID Cards & Eligibility

The 3 primary HIPPA Identifiers are:

• Member's full name, address on file & SSN

• Member's full name, phone # on file & DOB

• Phone # on file, DOB & Address on file

• Member's ID, Member's full name and Member's DOB

Associates in possession of ______________ are accountable to protect that information at all times, including while at work, at home, and while traveling.

• Anthem Purpose, Vision and Values

• Protected Health Information (PHI)

• Heath Insurance Portability and Accountability Act (HIPAA)

• Company Websites

A caller tells you they are calling for their sister and proceeds to give you their information. You notice that the caller is NOT listed on the policy. What is your next step?

• No further action is needed

• Request the caller provide the MEMBER’S full name and date of birth before you can disclose any PHI

• Ask if the member is available to speak with

• Request that the member be present on the call for you to disclose information

Susie, a member on the plan calls requesting her information. What would you choose for who is contacting us on the HIPAA Tool?

• Member

• Subscriber

• Informal Representative

• BCBS Plans or other insurance plans

Every time an associate steps away from his/her computer, he/she must lock the computer.

• Press F12 + Esc and select Lock OR press Alt + Tab and the letter E key

• Press Control + Alt + Delete and select Lock Computer OR hold the Windows key + the letter L key

• Press Control + Alt + End and select Log Off OR press the Shift key + the letter X key

What should I do differently if the member’s Relationship Status is listed as Unknown in Solution Central?

• Select the gender pronoun based on the member’s name

• Ask the member what is their gender

• Do not use any pronouns when speaking with the member

• Contact your manager or OE to report an issue with Solution Central

If a caller does NOT have his/her member ID number and will NOT give the Social Security Number, which other piece of identification can you obtain instead as an alternate verifier?

• Caller's mother's maiden name

• Caller's address

• Name of the caller's employer

• Name of the caller's medical plan

Which system houses the Confidential Communication and HIPAA Authorizations?

• Clarity

• Mainframe

• Solution Central

• CIRS

Which of the following DOES NOT define “no healthcare homework”?

• Follow-up timely when issues have been corrected

• Tell the member they need to contact the provider to get the information

• Call providers and vendors to get information for our members

What are a few things we can do to ensure we “Connect with the customer on a personal level and show genuine interest”?

• Use the customer’s name to build rapport, have patience and allow the caller to speak and provide assurance by acknowledging their concerns

• Stick only with the questions at hand, and do not attempt to make a connection with the caller

• Stick only with the questions at hand, and do not attempt to make a connection with the caller

• Put the member on hold immediately after the call comes in