Select the best answer.
Individual Session
AHCA
Education Session
Call
Select "Other" in the Follow-Up Information box and enter the new phone number in the space provided.
Select Requested Follow-Up and then enter the new phone number.
Refer to DCF/SSA to update that demographic information.
Refer to ACHA Medicaid Helpline to update demographic information related to complaints.
The person or persons the caller is complaining against.
The person or persons being affected by the issue or problem.
The person or persons that constitute a third party liability.
The person or persons that are the Target Party.
General Health Plans, Medical Issues, and Providers.
AHCA, DCF, SSA and DOEA.
Recipient, General Population, and Other.
General Health Plans, General Population, Specialty Plans and Pharmacies.
True
False
Recipients
Other
Target Party
General Population
AHCA
Billing and Payment
Marketing
Network Access
The Target Party
The person or persons being affected by the issue or problem.
What the caller is complaining about or who the caller is complaining against.
The complaint category assigned to the person or persons filing the complaint.
Escalate the call to a Supervisor for further assistance with the customer service issue.
Submit a call back request to have a Supervisor assist Anita.
Refer to AHCA Medicaid Helpline because they are required to process complaints against AHS.
Process the complaint request through HeathTrack and provide Anita with the complaint number.
Add Freddie Doe by typing his name into the blank box below the names in the Affected Individuals section.
Refer to ACHA Medicaid Helpline for further assistance in filing the complaint for non-listed members.
Refer to DCF to add Freddie Doe to the case in order to process the complaint in HealthTrack.
Create a task so that a supervisor may review the case and send the complaint to AHCA.
True
False
All documentation submitted in HealthTrack is public record.
Media, government officials and/or court may view documentation submitted through HealthTrack.
Choice Counseling agents should always proof-read all of their notes for spelling errors, incorrect punctuation, and grammar.
All of the above.
Process one complaint for each single issue at a time. You should process three separate complaints for all the three issues.
Inform Shakira that she must contact AHCA Medicaid Helpline for complaints related to multiple issues.
Refer Shakira to her plan to file a grievance against all three providers.
Process a complaint for one issue in HealthTrack. Once you are finished, add a new issue to the same complaint. Add as many issues as Shakira requests.
Place the request on the Discrepancy Log.
Remove the issue by clicking on the red X in the top right corner of the Complaint Wizard.
Advise the caller that they should be sure before filing multiple complaints.
Refer the caller to a supervisor for further assistance because once the issues are logged cannot be canceled.
Cancel the complaint by clicking cancel on the bottom left corner of the Complaint Wizard.
Encourage Rosita to file the complaint.
Complete the complaint without Rosita's authorization.
Submit a request to have a Supervisor call back and further investigate the issue.
True
False
Inform Tommy that agents are not allowed to disclose the complaint number and he will be notified by mail with a resolution to his complaint.
Give the complaint number to Tommy.
Refer Tommy to a supervisor because only supervisors may provide the complaint number.
Advise Tommy that he needs to contact AHCA Medicaid Helpline to obtain the complaint number.
The caller is filling a complaint with multiple issues like General, AHCA and HIPAA.
The tabs pop up just to let the agent know that the caller must file a complaint against General, AHCA and HIPAA.
The agent must go over all three tabs to verify if the caller has any complaint pending against General, AHCA and HIPAA.
The complaint must be sent to the General, AHCA and HIPAA for review.
Refer to a Supervisor
Refer to DCF/SSA/DOEA
Refer to the health plan
Refer to AHCA Medicaid Helpline
Commercial Organization
Authorized Agency
Provider
Health Plan
Immediately advise the caller that is not an option and end the call.
Advise the caller they are required to be in a plan to continue receiving services and ask what is their reason for wanting FFS/Straight Medicaid.
Advise the caller the request will be submitted and they will have straight Medicaid the 1st of the following month.
Submit the request to the supervisor for approval.
File a complaint in the complaint wizard.
Select the MC EX/SC Request button in HealthTrack and document the request.
Submit a task to a supervisor and request the removal.
Contact the SNU and the request they remove the condition.
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