Call Center Reminders

1. Call Center Reminders

2. Script and Security

3. Remember Script Guidelines • Greeting: “Thank you for calling ACS, A Xerox Company. My name is ___. The reference number for this call is <CRN#>. Again that’s <CRN#>. • Closing: “Is there anything else I can assist you with? Thank you for calling ACS, A Xerox Company.” • Additionally, Make sure you state: • CRN twice • Your name twice • Caller’s name twice • You must ask permission before placing a caller on hold AND remember to thank the caller for holding when you return. • Inform the caller that their hold time may exceed one minute.

4. Specialty Queue Call Script • When callers reach a specialty queue such as PBM, Nurse, or Helpdesk in error: State greeting: “Thank you for calling ACS, A Xerox Company. My name is ________, how may I help you”? If the inquiry is regarding billing, prior authorization, enrollment, black lung, energy, or 1099, state: “Unfortunately, the department you have reached is unable to assist you with your inquiry. Please dial 850-558-1818 and select option __ for assistance”. Options: • Billing – 4, 1 • Prior Authorization – 4, 3 • Enrollment – 4, 2 • Helpdesk – 4, 8 • 1099 – 5 • For information via the IVR (Interactive Voice Response) – 3

5. Specialty Queue Call Script • If the caller asks to be transferred, state: “I am unable to transfer your call, please dial 850-558-1818 and select the option pertaining to your call. Thank you for calling ACS, A Xerox Company”. For: FECA dial 850-558-1818 Black Lung dial 800-638-7072 Energy dial 866-272-2682

6. Remember Security – Provider Security • If provider calls with provider ID number: • Verify Name of Facility • If provider callswithoutprovider ID number: • Verify Tax ID, Name AND Address of Facility. • If the providerisenrolled/active: • Give the Provider their ACS Provider # and advise the Provider to place this number in box 33B of the CMS 1500 and or box 57 of the UB04. • If the provider is not enrolled: • Advise provider to download the application from the Web site and fax or mail it. The Web site is http://dol.owcp.acs-inc.com. Click on Forms and Links and then select the Program that the Provider needs to enroll under. Select Downloadable Forms next to Provider Enrollment. You can also offer to mail the enrollment forms to the Provider. • Continue to claimant security; provide general information (i.e. eligibility, fax numbers, mailing address)

7. Remember Security – Claimant SecurityFECA • If claimant or claimant representative calls with case number: • Verify name and date of birth. • If claimant or claimant rep calls without case number: • SS# must be given. Verify name, DOB, and date of injury (If more than 1 case is on file). • If SS# or DOI cannot be verified • Only provide general information. • If provider calls with case number: • Verify name of Claimant. • If provider calls without case number: • SS# must be given. Verify Name, DOB and date of injury (If more than 1 case is on file)

8. Remember Security – Claimant SecurityBLNG • If claimant or claimant representative calls with social security number: • Verify name and date of birth • If claimant or claimant rep calls without social security number: • Only general information can be given (i.e. mailing address, district phone • numbers) • If provider calls with social security number: • Verify name and date of birth • If provider calls without social security number: • Only general information can be given (i.e. mailing address, district phone • numbers)

9. Remember Security – Claimant SecurityENRG • If claimant or claimant rep calls with social security number: • Verify name and date of birth AND if claimant rep, this person must be • authorized in track case or the claimant MUST give you permission to speak • with this person. • If claimant or claimant rep calls without a social security number: • Only general information can be given (i.e. mailing address, district phone • numbers) • If provider calls with social security number: • Verify name and date of birth • If provider calls without social security number: • Only general information can be given (i.e. mailing address, district phone • numbers)

10. Call Verbiage

11. Drive Callers to the Web Portal • When you are routing a request to a different department (i.e. PA, billing), DO NOT advise the caller to call back to check on the status of their request. • Advise the caller to use the Web or IVR to follow-up on requests. • You should encourage the use of the Web portal to decrease call volume and increase efficiency. • Note: IVR is for FECA only

12. Verbiage for Follow-up Requests – PA New Request • PA Requests • When providing instructions for a new Authorization Request, please advise the provider to visit the Web Portal: • Ø   1. <Click> Forms & linksBelow the icon labeled DCMWC, • Ø     2. Of the (3) options listed, (FECA, DCMWC, DEEOIC) select the option for the program you are calling about. • Ø     3. Find applicable form needed on the left side of the page. • Ø     4. Submit your request using the instructions on the form. • “Once received, please allow 3 business days for processing before checking the status of your request on our website at owcp.dol.acs-inc.com or through our automated voice response system by calling 1-866-335-8319.”

13. Verbiage for Follow-up Requests – PA Existing Request • PA Requests • When providing instructions for an existingAuthorization Request that is forwarded to PA as a result of a phone call, please state: • “I will forward your request to our Prior Authorization Department at this time, please allow 3 business days for processing before checking the status of your request on our website at owcp.dol.acs-inc.com or through our automated voice response system by calling 1-866-335-8319.”

14. Verbiage for Follow-up Requests – New Bill • Bill Status • When providing instructions for a new Bill, not yet on file, advise the provider to: • “Please submit your bill to, (give applicable address). Once received, allow 28 business days for processing before checking the status on our website at owcp.dol.acs-inc.com or through our automated voice response system by calling 1-866-335-8319.”

15. Verbiage for Follow-up Requests – Processed Bill • Bill Status • When providing instructions for the status of abill, denied or paid status, advise the provider: • If the bill is paid, “Your bill has been paid and you should receive payment on (give date of the Thursday in Achieve). You can verify the status of paid bills on our website at owcp.dol.acs-inc.com or through our automated voice response system by calling 1-866-335-8319.” • If the bill denied in error, “I will forward your request to our Adjustments Department at this time, please allow 10 business days for processing”. You can verify the status of the bill on our website at owcp.dol.acs-inc.com or through our automated voice response system by calling 1-866-335-8319.”

16. Verbiage for Follow-up Requests – Processed Bill • Bill Status • If the bill denied accurately, “Please make the corrections to your bill and resubmit your bill for processing” (provide instructions on how to resubmit their bill).You can verify the status of paid bills on our website at owcp.dol.acs-inc.com or through our automated voice response system by calling 1-866-335-8319.”

17. Verbiage for Follow-up Requests – Enrollment • Enrollment Status • When providing instructions for a new Enrollment application, please advisethe provider to: • Select the applicable authorization form on our website at,http://owcp.dol.acs-inc.com… • Below the icon labeled DCMWC, <click> Forms & links • Select the option (FECA, DCMWC, DEEOIC) for your specific program. • Find applicable enrollment for on the left side of the page, labeled “Provider • Enrollment, <click> Downloadable Form to print the application with instructions. • Complete/Submit your request using the instructions on the form. • “Once received, please allow (5) business days for processing. At which time you are approved, you will receive a Welcome Packet by mail.”

18. Enrollment Reminders

19. Subsystem 9 Provider Search • If a provider is checking enrollment status, get the Tax ID and place it in the “Social-security or Employer ID” field in Achieve Subsystem 9. • If the correct name and address is located, check screen 1 and 7 for the provider status. • Screen 1 should state “Active” on the first line and Screen 7 should have a “P” in the PAR field for participating. If screen 1 does not state “Active” AND screen 7 does not state “P”, the provider file is not active. • NOTE: If you see I-term (license expired) or K-term (file has been deactivated or provider has not billed within 2 years) on screen 1, please simply advise the provider to re-enroll.) Screen 7 could have various statuses: P – Participating/Active R – RTP’ed N – In process of verification. (The provider should be receiving a call to verify their information on the enrollment documents.) S – Pending (The information from the enrollment file has been keyed in Achieve but no verification has began yet.) • Please note, all status can be found in the Quick Reference Guide.

20. Searching for Provider Enrollment Applications • In Omnitrack, select <Tasks>, then <Search Correspondence> • In the Custom field dropdown menu, select <Claimant ID> and in the Custom Value field, enter the Tax ID for the provider and press the magnifying glass to search. • Pay attention to the date of the CRN and the category and subject of the CRN. Select the date based on what information the caller gives you. • The most recent CRN will be listed first. This is usually the one you would select, unless your caller states otherwise. • Also, you should select a category and subject based on the categories and subjects used by the enrollment processors. These include subjects such as: • 1st Attempt – PE Finance, 2nd Attempt – PE Finance, • Change of Address Form Received • Change of Address RTP • Correction to Record • Correspondence Received • Correspondence RTP • Enrollment Application RTP • Enrollment Application Received

21. Searching for Provider Enrollment Applications • An enrollment processor would NOT use categories and subjects such as: • Application Status • Application Assistance • Enrollment • These categories and subjects would be used for call center agents. You would never document any category and subject used by the enrollment processors. The categories and subjects listed above should be used by the call center agents when documenting enrollment calls.

22. Enrollment RTP Reasons • Enrollment RTP reasons can be found in SIR on the left hand side under PEN Legend. • You should look at the note in SIR on the left hand side to show the RTP reasons. The reasons will appear in two sets. (i.e. 3/39). • The first number gives you an overview idea of what is wrong with the enrollment application. • The second number gives you specific details as to what is wrong. • In this example, the first number 3 means Practice Type and reason 39 means Incorrect Practice Type. • Requests should NOT be routed to Enrollment to provide an explanation of what an RTP reason means. In addition to the PEN legend, all RTP reasons are located in the Quick Reference Guide.

23. EFT Verification • If a provider suddenly stops receiving EFT payments (meaning payments are being rejected in Achieve) and the provider file has not been updated, there is no need to send a request to verify EFT. • The provider should send their current banking information for verification and update.

24. List of Providers • The Enrollment Department can provide a list of provider Ids that are enrolled under a specific tax id. However, the enrollment department CANNOT provide a list of individual doctors listed under the group. • This spreadsheet can only be emailed as a PDF; it cannot be faxed or mailed. Remember to document the provider’s email address before ending the call.

25. Welcome Packet Requests • Welcome packets cannot be sent to any other address if it is not listed on the provider file (screen 1 or 3 in Subsystem 9). • CRNs that are routed to request the Welcome Packet to be sent to another address other than the physical or billing, cannot be processed. • Welcome Packets and Enrollment Packets are two separate documents. • Welcome Packets are sent to the provider once they are enrolled. • Enrollment packets are the actual forms to enroll.

26. PA Reminders

27. Inpatient Stay Requests • If a provider is requesting authorization for an inpatient admission, whether it is a retro or prior authorization, this should ALWAYS be routed. Complete the inpatient template (located on the Universal Template) and place at the very TOP of the CRN. The agent should use Rev Code Range 0100-0219 when filling out template. • Admitting Diagnosis: (include admitting diagnosis code from provider) • Rev Code: (use Rev code range 0100-0219) • Admission Date: (include admission dates – from and to dates are required) • Length of Stay: (include the number of nights claimant will be inpatient) • Surgery Date: (only include if the reason for admission is surgery) • Reason for Admission: (include reason claimant is staying in hospital – i.e. • inpatient rehab, surgery, observation, etc.) Inpatient stay • is not a sufficient reason. • DCN: (include DCN for any medical support, if available)

28. Inpatient Stay Requests • Next, fill out the PA portion of the Universal Template and route the completed CRN to Work Unit: Prior Authorizations. • DX/Accepted Conditions: • DCN: • DOS: • Procedure/HCPCS/NDC Codes: (rev code 0120-0219) • Units/Visits: • Price: (only for DME) • Body Part:

29. Resources • The Quick Reference Guide is located on the J-Drive under a folder named “Quick Reference Guide.” You should refer to this book to answer questions before asking for assistance.

30. Dress Code

31. Dress Code • The following is an outline of the ACS, A Xerox Company dress code. Please adhere to the dress code at all times. Failure to comply may result in disciplinary action and/or employee returning home to change clothes without pay. If the employee returns home he/she must return to work immediately. • Open toe shoes may be worn year round • Thong shoes are not permitted - exception on Saturday • Sneakers and T-shirts are only permitted on jeans day – Monday, Friday • Hosiery and socks are not required • Skirts must be at least knee length • Pants must be at least ankle length - exception on Saturday • No hats or head gear permitted – exception on Saturday • Belts must be worn when belt loops are visible - exception on Saturday • Pants must be on the waist (no sagging)

32. Dress Code (continued) • Absolutely no halter tops, tank tops, tube tops, capris or spaghetti straps. • You will be able to wear sleeveless blouses but these sleeves must come to the shoulder and should fully cover any undergarments, if not a jacket must be worn or be sent home to change clothes or get a jacket.

33. New Quality Assurance Database

34. New QA Database • Effective today, all agents and processors will have the ability to review their QA scores online. You will be able to pull your QA scores for the last 2 months for review. You will have access to do this at your convenience/preference. Follow the steps below to start your journey to QA freedom!

35. Step 1 – Agent QAC ID and Password • 1.  Before this class, your supervisor should have assigned/given you have your “Agent QAC ID and QAC Password. If not, please see your supervisor.

36. Step 2 – Access the Database on J-Drive • Access the new “QAC Agent Reporting” Microsoft Access Database located on the J:Drive in the following folder: J:\QAC Agent Reporting

37. Step 3 – Click the Icon • From the QAC Agent Reporting folder, double click the “QA Agent reporting” DB (database) icon. (If the database is in current use, you may see two icons. However, never click the icon with the lock displayed. The correct db icon does not have a lock pictured on the icon.) Click this icon. Click This Icon this icon.

38. Step 4 – Click “Open” on Pop-up • First time users may be prompted with a pop-up, click “Open”.

39. Step 5 - Search • Once the database opens, the agent reporting criteria form labeled “QAC Quality Assurance Center, Agent Reporting” will display. Input the following and click save criteria: • Begin Date • i.     Month/Day/Year • ii.     5/19/12 • End Date • i.     Month/Day/Year • ii. 05/19/12 • Agent QAC ID • i. Case sensitive • QAC Password • i.Case sensitive (Note: In an effort to keep the system’s response time quick and user friendly, the system will only allow you to retrieve no more than 2 months of past data.)

40. Step 6 – Save Criteria • Click the “save criteria” button.

41. Ste 7 – Export Report to Folder • Click the “Export Report to Folder” button. A pop-up window may appear, click “OK”.

42. Step 8 – Save the Report • Save the report to the drive/folder of choice. • a.      Select the drive for your department. For example, all call agents should have access to the J drive. • b.     Select your folder on the department’s drive. • c.      You may keep the file name “QAC Agent Reporting .rtf” or input a new file name. (Please keep in mind that when exporting, if you choose to change the file name, the file name must end with .rtf ) • d.      The “Save as type” field will auto populate “All Files” - do not change. • Click ok.

43. Step 9 – Export Complete • File export is now complete. Go to the designated drive/folder to review your QAC Agent report.

44. See Supervisor for handouts and Questions!

45. Test Your Knowledge

46. Access Quiz