Automated Voice Response Eligibility Verification Subsystem Call Flow Manual
|
|  Yüklə 0.86 Mb.
|
Section 11 – Card Issuance VerificationThe Card Issuance inquiry can be made from the Main Menu or from the submenu of a Member’s response indicating Card Issuance information is available. If the user inquires on Card Issuance from the Main Menu, the call flow will begin at Step 64.0. STEP 64.0 – Obtain INQUIRY ID For Card IssuanceTo obtain Card Issuance information from the Main Menu, the user must enter a valid Medicaid inquiry ID, from date-of-service and to-date-of-service. First, the system prompts the user for a inquiry ID. “Please select one of the following options, followed by the pound sign.” “To inquire using Medicaid number, press 1.” “To inquire using social security number, press 2.” “For assistance from a customer service representative, press 0. Member Number Inquiry: If the caller selected option 1, then a prompt for the Member Number follows. “Please enter the ten-digit Medicaid member ID number followed by the pound sign.” The system edits the Member ID for ten numeric digits. If the user entered a Member ID in an invalid format, the system replies: “Member number (MEMBER–NUMBER). That number is invalid. Please reenter.” Social Security Inquiry If the caller had selected option 2, then a prompt for the Social Security Number, follows. “Please enter the member's Social Security followed by the pound sign.” The system currently edits the SSN (i.e. numeric & length). If the user did not enter a valid format SSN, the system replies: “Social Security Number (getSSN) is invalid.” Then the caller is re-prompted to enter the number. Once a valid formatted SSN has been provided, the caller is then prompted to confirm the SSN that was entered. “You entered (getSSN)” “If this is correct, press 1, or to re-enter press 2, followed by the pound sign',”
STEP 64.4 – From DOS For Card IssuanceWhen the system receives a correctly formatted Member identification number, it prompts the user for a From date-of-service: “Please enter the eight digit FROM date-of-service in month, day, century, year format followed by the pound sign, or enter a pound sign only for today's date.” The user must enter the From date-of-service in a MMDDCCYY format. The system edits the date to ensure it is in the correct format and is a valid date. If the date-of-service is not a valid date, the system informs the user: “That date is not valid. For example, July 1, 1995 would be entered as zero seven, zero one, nineteen, ninety five. Please enter the eight digit From date-of-service in a month, day, century, year format.” The date must be no greater than one-year from today’s date. If the date-of-service is too old, the system informs the user: “We are unable to process dates older then (CURRENT-DATE- 365). Please enter the eight digit From date-of-service in a month, day, century, year format.” Once the user enters a valid From date-of-service, the system resumes the call flow at a Step 64.5.
STEP 64.5 – To DOS For Card IssuanceWhen the system receives a correctly formatted From date-of-service, it prompts the user for a to-date-of-service: “Please enter the eight digit TO date-of-service in a month, day, century, year format followed by the pound sign or enter a pound sign only if the TO date of service is the same as the FROM date of service.” The user must enter the To date-of-service in a MMDDCCYY format. The system edits the date to ensure it is in the correct format, greater than or equal to the From date-of-service. If the To date-of-service is not a valid date, the system informs the user: “That date is not valid. For example, July 1, 1995 would be entered as zero seven, zero one, nineteen, ninety five. Please enter the eight digit To date-of-service in a month, day, century, year format.” If the To date-of-service is a future date the system informs the user: “We are unable to process dates beyond (CURRENT-DATE). Please enter the eight digit To date-of-service in a month, day, century, year format.” Once the user enters a valid to-date-of-service, the system resumes the call flow at Step 64.6
STEP 64.6 – Card Issuance host transactionSince the Card Issuance information resides at the host, the system sends a transaction to the host to request Card Issuance information. In some cases, there may be a slight delay while the system waits for the information to return from the host, so the system informs the user with the message: “Please wait while the requested information is retrieved.” STEP 64.7 – Member Not On File For Card IssuanceIf the Member ID does not exist on the Member Eligibility Master File, the system informs the user: “Member ID (MEMBER-ID) is not on file.” If the Social Security Number had been given as the inquiry ID, the system responds with: “Social Security Number (MemberSSN) is not on file. The system resumes the call flow at Step 2.0 Menus For Provider.
STEP 64.8 – Card Issuance dataIf the user enters a valid ID the system will respond with the following message: The member (MEMBER_ID) has a card issued on (CARD_ISSUED_DATE)
The member (MEMBER_ID) has no card issued on file. Either message continues on with the phrase: with beginning coverage date of (BEGIN_COVERAGE_DATE) and ending date of (END_COVERAGE_DATE).”
STEP 64.9 – Card Issuance Continue MenuAt this point the system has completed the Card Issuance information. The caller is given the option to inquire about another Member’s plastic card data and press 7 or returning to the Main Menu or transferring to a Customer Service Representative. The system prompts the user accordingly. “To inquire about another Member’s Plastic Card Issuance data, press 7. To hear the Member’s name, press 6. To return to the Main Menu, press star 99. For assistance from a Customer Service Representative, press 0. If this concludes your call, you may hang up.” If the user presses 7, the system resumes the call flow at Step 64.0. If the user presses *99, the system resumes the call flow at Step 2.0. If the user presses 0, the call is transferred to a Customer Service Representative.
|