2014 - Qm - Securing The Call

1. The customer's daughter calls and gives the customer's full name, date of birth and last four of social to the BA. The BA asked to speak with the customer to approve the daughter as a HIPAA representative. The customer approves the daughter to be a HIPAA. Would the customer still need to secure their record before authorizing the daughter as HIPAA even though the daughter gave all necessary pieces of information?

Yes

No

Even though the daughter gave all necessary pieces of information, she was not authorized in the SSC to secure the call at that time. The customer would have to secure their record, authorize the daughter and then the daughter can speak on behalf of the customer.

Explanation

Even though the daughter gave all necessary pieces of information, she was not authorized in the SSC to secure the call at that time. The customer would have to secure their record, authorize the daughter and then the daughter can speak on behalf of the customer.

2. MR and MRS call to enroll. The BA asks MR for his: full name, last four of SSN and phone number and then asks MRS for her: full name and date of birth. Since the customers both share the same phone number, the BA did not ask MRS to verify another piece of information. How would QM score the Secure the Call portion of the form?

Yes

Major

N/A

Each party must provide their full name and then 2 of the 3 (DOB, last four of SSN, phone number) separately

Explanation

Each party must provide their full name and then 2 of the 3 (DOB, last four of SSN, phone number) separately

3. MR and MRS call to talk about MR's plans. They do not speak about MRS account. They are linked accounts in the SSC.Indicate who needs to be secured:

MR only

MRS only

MR and MRS

All callers must be secured if they have a record and the records are linked in the SSC.

Explanation

All callers must be secured if they have a record and the records are linked in the SSC.

4. The BA put plans in the cart for the customer and transferred to an ADP to complete the applications. The ADP secured the customer's record and completed his applications. Did the ADP need to re-secure the customer's account?

Yes

No

The first BA/CSR/ADP to receive the call is responsible for securing the call. A BA/ADP is not responsible for securing the call upon receiving a transfer. The BA/ADP receiving the transfer can assume that all parties and related accounts were secured.

Explanation

The first BA/CSR/ADP to receive the call is responsible for securing the call. A BA/ADP is not responsible for securing the call upon receiving a transfer. The BA/ADP receiving the transfer can assume that all parties and related accounts were secured.

5. During the sales portion of the call, the line disconnects. The customer calls back within 2 minutes and is routed to the same BA.The BA does not have to secure the call if the customer calls right back and is routed to the same BA.

True

False

All calls must be secured.

Explanation

All calls must be secured.

6. If the customer calls and only asks general questions, would the agent be required to secure the call?

Yes

No

All calls must be secured using HIPAA guidelines, even if no PHI or specific account information will be discussed.

Explanation

All calls must be secured using HIPAA guidelines, even if no PHI or specific account information will be discussed.

7. The customer's daughter is POA for her mother and is calling on behalf of the customer. What pieces of information are required to secure the call?

POA full name and DOB, Customer full name, 2 of 3 (for customer): DOB, last 4 of SSN, phone number

POA full name, Customer full name and 2 of 3 (for customer): DOB, address, phone number

POA full name, Customer full name, 2 of 3 (for customer): DOB, last 4 of SSN, phone number

Customer full name, POA full name and 2 of 3 (for POA): Last 4 of SSN, phone number, DOB

The correct answer is POA full name, Customer full name, 2 of 3 (for customer): DOB, last 4 of SSN, phone number. In order to secure the call, the customer's daughter, who is acting as the Power of Attorney (POA), needs to provide her full name and the customer's full name. Additionally, she must provide two out of three pieces of information for the customer, which include the customer's date of birth (DOB), last 4 digits of their social security number (SSN), and phone number. This combination of information helps to verify the identity of both the POA and the customer.

Explanation

The correct answer is POA full name, Customer full name, 2 of 3 (for customer): DOB, last 4 of SSN, phone number. In order to secure the call, the customer's daughter, who is acting as the Power of Attorney (POA), needs to provide her full name and the customer's full name. Additionally, she must provide two out of three pieces of information for the customer, which include the customer's date of birth (DOB), last 4 digits of their social security number (SSN), and phone number. This combination of information helps to verify the identity of both the POA and the customer.

8. MRS is discussing plan options with a BA. Another female asks a question about the Coverage Gap. The BA answers her question without asking who she is or asking the customer if she consents to having this person on the line listening to her enrollment options. Would QM score Secure the Call as Non-Compliant?

Yes. Everybody on the line must be secured.

Yes. The customer would have had to authorize that person prior to this phone call to be their HIPAA representative.

No. If the other person doesn't have a record in the SSC, then they don't have to be secured.

OneExchange best practice is to identify that person and add them as a HIPAA, but we will not fail a call if this is not done. However, we should coach the ADP/BA to identify the third party and attempt to add them as a HIPAA Approved Rep.

Explanation

OneExchange best practice is to identify that person and add them as a HIPAA, but we will not fail a call if this is not done. However, we should coach the ADP/BA to identify the third party and attempt to add them as a HIPAA Approved Rep.

9. The HIPAA calls and secures the call. The customer joins the call 30 minutes later. Would the customer need to secure his/her record?

No. The record was already secured by the HIPAA

If a caller is already listed as a HIPAA on the account and secures the call, the call does not need to be secured again if the customer joins the call.

Explanation

If a caller is already listed as a HIPAA on the account and secures the call, the call does not need to be secured again if the customer joins the call.

10. On an inbound call, the BA stated the customer's first and last name and then asked for their last four of social security and date of birth. Would this be considered Non-Compliant because the BA stated the customer's first and last name instead of asking the customer for it?

Yes

No

QM Definitions: On an inbound call, if the ADP/BA states the Customer's full name, this will not cause the call to be Non-Compliant.

Explanation

QM Definitions: On an inbound call, if the ADP/BA states the Customer's full name, this will not cause the call to be Non-Compliant.

11. The customer calls in and asks to speak with a John Jones, a BA. The BA transferred the call to John Jones without securing the call. The John Jones does not need to secure the record.

True

False

The first agent to answer the call is required to secure the call.

Explanation

The first agent to answer the call is required to secure the call.

12. The TPA is calling on behalf of the customer with the customer not on the line. Can we speak to the TPA without securing the record?

Yes

No way

The BA/ADP does not need to secure the call. EH has a PHI data sharing agreement which allows us to share data without securing the call.

Explanation

The BA/ADP does not need to secure the call. EH has a PHI data sharing agreement which allows us to share data without securing the call.

13. MR called and wants to enroll into the same plan as his wife but he doesn't remember which plan she has. His wife is not on the call today. MR is not listed as HIPAA on MRS account.What can the BA disclose about the plan MRS has without being Non-Compliant for Secure the Call? Check all that apply.

Plan Name

Plan Type

Premium

Effective Date

If a caller states that that they would like to enroll in the same plan as their spouse, it is acceptable for the BA to give the plan name/type without securing the spouse's account; however, this is the only information that can be disclosed.

Explanation

If a caller states that that they would like to enroll in the same plan as their spouse, it is acceptable for the BA to give the plan name/type without securing the spouse's account; however, this is the only information that can be disclosed.

Submit

14. The BA asked the customer for his full name, date of birth and zip code in order to secure the call. How would QM score the Secure the Call portion of the form? Check all answers that apply.

Yes

Major

Coach

N/A

If the ADP/BA uses the ZIP code as one of the pieces of information to secure the call, QM will not mark down for this line item; however this should be coached. Coaching note should inform that QM cannot guarantee that this will not fail in the future and also included in the body of the email.

Explanation

If the ADP/BA uses the ZIP code as one of the pieces of information to secure the call, QM will not mark down for this line item; however this should be coached. Coaching note should inform that QM cannot guarantee that this will not fail in the future and also included in the body of the email.

Submit

15. Match the following types of callers to their definition in the Secure the Call procedure document

Customer

Power of Attorney

Legal Guardian/Conservator

Living Will

HIPAA Approved Representative

Submit