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Automated Voice Response Eligibility Verification Subsystem Call Flow Manual


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Automated Voice Response Eligibility Verification Subsystem Call Flow Manual



Kentucky DDI MMIS Project
Cabinet for Health and Family Services
Kentucky Medicaid Office

January 5, 2009






EDS: BPM - APM

Plano Medicaid Implementation Services
State Operations Division

Leveraged Technology Group - VISTA

Analysis Phase

Modification Log

Date

SE

Description

07/20/2007

M. Browning

Removed Eligibility by Name lookup and added checking Claim Status by TCN.

09/12/2007

M. Browning

Added program code check to Eligibility transaction.

12/06/2007

M. Browning

Added Outpatient Rehab Service Limitations

10/01/2008

M. Browning

Added new co-pay segments

01/05/2009

M. Browning

Added new upfront Provider Enrollment message

Summer 2009

M. Arterburn

CO11842 – Add SSN inquiry to Eligibility Inquiry

Table of Contents

Automated 1Voice Response System Application Introduction 3

Call Flow Introduction 9

VOICE MEMBER ELGIBILITY VERIFICATION SYSTEM 11

TABLE 1: PROCEDURE CODE WITH DESCRIPTION 77

TABLE 2: Application Messages File 85

Table 3: County Code 105

Table 4: Benefit Packages 107





Automated 1Voice Response System Application Introduction


The purpose of this section is to present a detailed description of the proposed call flow for the Kentucky Legacy MMIS Voice Response System. The call flow describes the content and order of the prompts the automated voice response system speaks to the user during a phone call. The following sections discuss global messages and events, special function keys, and the normal call flow.

The GLOBAL MESSAGES AND EVENTS section describes messages and events that occur normally or only in exceptional situations during the call. The global messages and events typically include system and user error messages. It simplifies the normal call flow narrative to describe these messages separately.

The SPECIAL FUNCTION KEYS section describes key sequences that the user can enter on the touch tone keypad to perform specialized functions. Specialized functions include repeating data, correcting data, and entering alphabetic data.

The NORMAL CALL FLOW section describes the series of prompts, user inputs, and system responses which occur during the voice inquiry session. Included in this section is a discussion on how the voice response system speaks data to the user.


GLOBAL MESSAGES AND EVENTS


There are several global messages used by the Automated Voice Response Eligibility Verification (AVREV) system to inform the provider of the result of their transaction entry. Rather than list these each time in the call flow narrative, they are explained in detail in this section.

Data Entry Error


If the user makes a data entry error and there is no error message specific to the current step, the system issues the following message:

"That entry is invalid. Please re-enter.”

If the error is at a menu prompt and there is no messages specific to the current step, the system issues the below message, then reprompts the user with the offering.

"Invalid option. Please re-enter.”


Max Attempts


The user is currently allowed three attempts to correctly enter the requested data. If the user exceeds this limit on user data entry errors, the system terminates the call after it issues the following message:

“We’re sorry you have not entered the required information at this step. If you would like assistance from a Customer Service Representative press 0 followed by the pound sign.”


Max Inquiries


The user is limited to five inquiries per session. Once this limit is exceeded, the system terminates the call after it issues the following message:

“You have met the maximum of five inquiries. Please call again later. Thank you for calling the Kentucky Automated Voice Response Eligibility System.”


Host Time Outs


The host computer currently allows two time outs. On the first time out the user receives the following message:

“Please wait while the requested information is retrieved.”

If the host does not respond after the second time out or if an error occurs during the transaction processing the system transfers the call during normal business hours 7am to 6pm ET, Monday through Friday with the following message:

“Currently the system is unable to process your request. Please hold for a Customer Service Representative.

If the host does not respond after the second time out the system issues the following message:

“Currently the system is unable to process your request, please try later. For assistance from a Customer Service Representative please call back between 7AM to 6PM Eastern Time, Monday through Friday except weekends and state recognized holidays and we’ll be happy to assist you.”


Transfer To Customer Service Representative


If the system attempts to transfer a call to a Customer Service Representative during normal business hours 7 am to 6 pm ET, the message is:

“Please hold for a Customer Service Representative.”

If the system attempts to transfer a call to a Customer Service Representative on the weekend or a state recognized holiday, it issues the following message:

“We’re sorry our office is closed. We are open from 7AM to 6PM, Monday through Friday, except weekends and state recognized holidays. Please call back and we’ll be happy to assist you.”

If the system attempts to transfer a call to a Customer Service Representative and encounters a busy signal or after normal business hours of 7am to 6 pm ET, Monday through Friday, it informs the user as follows:

“Currently all Customer Service Representative lines are busy. Please try again later.”

The system completes every call with the following message:

“Thank you for calling the Kentucky Automated Voice Response Eligibility Verification System. Goodbye.”


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