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WorksheetsHIPAA/CARE/Call Management
Total questions: 18
Worksheet time: 10mins
What does "HIPAA" mean?
Health Insurance Portability and Accounting Act
Health Insurance Plausibility and Affordability Act
Health Insurance Portability and Accountability Act
Health Insurance Portability and Advisory Act
What 3 primary pieces of HIPAA information should you get on every call?
Member's name, address and DOB
Member's SS#, DOB and Phone#
Member's name, ID# and SS#
Memeber's Full Name, ID# and DOB
What does "PHI" stand for?
People's Home Information
Protected Home Information
Protected Health Information
Private Health Information
Where are HIPAA authorizations housed?
The Marriott
CIRS
Pulse
Solution Central
What does the 'C' in CARE stand for?
Collect as much information as possible from the member
Connect with the Customer on a Personal Level & Show Genuine Interest
Collaborate with the member to show that you are listening
Cookies
T/F If the member's Relationship Status is listed as 'Unknown' in Solution Central I should use whatever gender the member sounds like on the phone.
True
False
HIPAA True or False - If a person (not the subscriber) is calling for another adult member, you must ask if that member is available to speak every time, even when the caller has verified all information.
True
False
What does the 'A' in CARE stand for?
Always Stay Level-headed
Always Assert Power
Always Be ASSERTIVE With the Customer
Always Communicate With Confidence & Knowledge
True or False - Saying "um" and using other "filler words" show confidence.
True
False
True or False - When answering a call, immediately greet, introduce yourself and offer assistance.
True
False
Large Group plans have a member population of more than 100 employees.
True
False
How long is a member eligible for Federal COBRA coverage when the employee, as well as their spouse and their dependents, lose coverage because of a termination or reduction of hours?
12 months
18 months
24 months
36 months
True or False - EVERY time you walk away from your computer you should lock it.
True
False
HIPAA - When a parent calls about a minor child, what option should you choose for 'Who is Contacting Us'?
Member
Informal Representative
Parent/Legal Guardian
Attorney
Gayle, the subscriber, is calling for information about herself. Can you release benefit information to her after she has been properly verified?
Yes
No
Subscriber: Eugene K. Jones
ID#: 123A4567
DOB: 12/4/1960
411 E. State St, Ithaca NY 14850
Blanche Jones is calling for her husband and she needs to know if his plan is still active because he is having a surgical procedure next week. He is not available to speak to you. Can you release that information to her?
Yes, she has verified all of his information
No, because he is not available
No, because she does not qualify for "inferred informal rep" status
Yes, because she has verified all of his information and she qualifies for "inferred informal rep" status
Mary, who is not the policy holder, calls in for her 19 year old son Michael, who is away at school, with questions about how much they will owe for a claim that she will be paying for him. What should you choose for 'Who is Contacting Us' to be able to try and help Mary?
Member
Informal Representative
Other Family and Friends
Parent/Legal Guardian
A subscriber is calling about their own policy, but the information given is incorrect. After asking the subsciber to repeat the information, it is still incorrect. What should you tell the subscriber since you cannot verify their information?
I'm sorry, but you do not have a policy with us
I'm sorry but without being able to verify your identity, I will not be able to share information with you today
Go ahead and give them the information they are calling for and tell them the information they gave was "close enough"
No, that's not correct. You will have to call back later
