Automated Voice Response Eligibility Verification Subsystem Call Flow Manual

Section 3 - KenPAC Verification

STEP 13.0 – Obtain INQUIRY ID For Kenpac

First, the caller is prompted to indicate which ID will be used:

“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',”

If the user enters a valid inquiry ID, the system will continue at Step 14.0.

STEP 14.0 – From DOS For Kenpac

“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 beyond (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 Step 15.0.

STEP 15.0 – To DOS For Kenpac

“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 - 365). Please enter the eight digit To date-of-service in month, day, century, year format.”

Once the user enters a valid To date-of-service, the system resumes the call flow at Step 15.2.

STEP 15.2 – Kenpac’s Information Response

“Please wait while the requested information is retrieved.”

The Automated Voice Response System provides information for up to five KenPAC segments if the provider request span dates (example 01/01/96 to 04/01/96). The system checks the response received from the host to determine whether or not the Member has KenPAC. If the Member has one or more segments within the span dates the system continues the call flow at Step 16.0. If the Member has KenPAC for a portion of dates, the system will continue at Step 17.0.

STEP 15.5 – Member Not On File For Kenpac

“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.

The call flow is continued at Step 13.0, Obtain Inquiry ID for KenPAC.

STEP 15.9 – Non Eligibility For Specified DOS For Kenpac

“Member (MEMBER-ID) is not eligible for Medicaid benefits from (FROM-DATE-OF-SVC) through (To-DATE-OF-SVC).”

.

The call flow is continued at Step 17.4 for KenPAC Continue Menu.

STEP 16.0 – Span Date Kenpac Eligibility

“Member (MEMBER-ID) has KenPAC from (FROM-DATE-OF-SVC) through (TO-DATE-OF-SVC), provider phone number is (PROV. PHONE-NUMBER or “IS NOT AVAILABLE”), and provider name is (PROVIDER NAME).”

If the system has spoken information for the last or only KenPAC segment, the system continues the call flow at Step 17.4 for KenPAC Continue Menu.

If the system has information for another KenPAC segment, it pauses to give the user a chance to record the information from the last response. The system then provides the user with the following options:

“There is/are (NUM-OF-REMAINING) KenPAC segments remianing. To hear information for the next KenPAC segment, press 1. To skip the remaining segment information, press 2.”

If the user presses 1, the system resumes the call flow at step 16.0. If the user presses 2, the system resumes the call flow at Step 17.4 for KenPAC Continue Menu

The system will speak three KenPAC segments and on the 4th segment the system will provide the user with the following options:

“There is/are (NUM-OF-REMAINING) KenPAC segments remianing. For assistance from a Customer Service Representative, press 0. To skip the remaining KenPAC segment information, press 2.”

If the user presses 0, the call is transferred to Customer Service Representative. If the user presses 2, the system resumes the call flow at step 17.4.

If the member is eligible, but has no KenPAC coverage, then the system speaks:

Member Number (MEMBER-ID) has no KenPAC coverage.

The call flow proceeds to the Continue Menu options.

STEP 17.0 – Partial Kenpac Eligibility

“This Member has partial KenPac for coverage.”

If the call is during provider representative hours, then the following message is spoken:

“Please select one of the following options, followed by the pound sign. For assistance from a Customer Service Representative, press 0. To continue, press 2.”

If the user presses 0, the call is transferred to a Customer Service Representative. If the user presses 2, the system resumes the call flow at Step 17.4. After the first time-out, the caller is disconnected with the hang-up message.

If the call is after hours then the following message is spoken:

“We’re sorry, our office is closed. We are open from 7 AM to 6PM, Monday through Friday except weekends and holidays. Please call back and we’ll be happy to assist you. Thank you for calling the Kentucky Automated Voice Response System”.

If the user presses 2, the system resumes the call flow at Step 17.4. After the first time-out, the caller is disconnected with the hang-up message.

STEP 17.4 – Kenpac Continue Menu

“To inquire on another Member’s Eligibility, press 1. To return to the Main Menu, press star 99 . If this concludes your call, you may hang up. For assistance from a Customer Service Representative, press 0.”

If the user presses 1, the system resumes the call flow at Step 13.0. 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.

STEP 17.5 – Kenpac Continue Menu With Name Option

“To inquire on another Member’s Eligibility, press 1. To hear the Member’s name, press 6. To get more information about this Member’s KenPAC information, press 2. To return to the Main Menu, press star 99 . If this concludes your call, you may hang up. For assistance from a Customer Service Representative, press 0.”

If the user presses 2, the system resumes the call flow at Step 13.0. If the user presses 6, the system resumes the call flow at Step 17.6. 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.

STEP 17.6 – Member Name For Kenpac

“The Member’s last name is (LAST NAME) and first name is (FIRST NAME).”

The last and first names are spoken using Text-To-Speech. The system resumes the call flow with the previous step and repeats the sub-menu.