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HIPAA- Health Insurance Portability and Accountability Act: to ensure data transmitted electronically is readily accepted and recognizable by transaction recipients.
PHI - Protected Health Information
> Names
> Phone numbers
> Account numbers
> Birthday
> SSN
>>>Define Each Caller Type<<<
>: Authorized Representative
>: Deceased Member
>: Employer Group
>: Internal Caller
>: Member
>: Power of Attorney/Guardian/Conservator
>: Provider
First Phase:
Discovery
Seek Advice
Quoting
Bind
Second Phase
Pay Premiums
Manage
Make Claims
Renewal / Retention
Member's Journey
Enrollment- member is welcomed, profile is set up, provider is selected, benefits are reviewed
Onboarding-there are set communication outreach times at 30,60,90 days of enrollment (30,60,90 days to pay their premiums) so their insurance will be active
Building Relationships- CSR can begin building rapport with each member
Access to Care- encompasses the member's ease of contacting clinics, access overall, and appointment scheduling
Quality of Care- this stop involves participating providers, coverage, preventive care. The needs of the member is met
Care Coordination- this vital stop includes healthcare coordination, referrals to specialty services, coverage and
Billing- ensures that the member understands their billing, specifically for their premium, and has them set up any autopay chargers (Premiums of members are depend on them)
Member Feedback- at the end of the plan year, the member reflects
INSURANCE BASICS:
Disability Insurance
Property Damaged Insurance
Auto Insurance
Life Insurance
Vision Insurance
Dental Insurance
Health or Medical Insurance
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