Automated Voice Response Eligibility Verification Subsystem Call Flow Manual
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Section 7 - Lockin Eligibility VerificationSTEP 38.0 – Obtain INQUIRY ID For LockinTo obtain Lock In eligibility 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 an 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',” If the user enters a valid inquiry ID, the system will continue at Step 39.0. STEP 39.0 – From DOS For LockinWhen the system receives a correctly formatted ID, 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 followed by a pound sign. The system edits the date to ensure it is in the correct format and is a valid, non-future date. The date must be no greater than one-year from today’s date. If the date-of-service is not a valid date, the system informs the user: “That date is not valid. For example, July 01, 1995 would be entered as zero seven, zero one, nineteen, ninety-five. Please enter the eight digit from date-of-service in month, day, century, year format.” If the From 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 From date-of-service in month, day, century, year format.” Once the user enters a valid from date of service, the system resumes the call flow at Step 40.0.
STEP 40.0 – To DOS For LockinWhen 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 followed by a pound sign. The system edits the date to ensure it is in the correct format, greater than or equal to the form-date-of-service, and is a valid, non-future date. It the To date-of-service is not a valid date, the system informs the user: “That date is not valid. For example, July 01, 1995 would be entered as zero seven, zero one, nineteen, ninety-five. Please enter the eight digit to date-of-service in 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 40.2.
STEP 40.2 – Lockin Host TransactionSince the Lock In information resides at the host, the system sends a transaction to the host to request Lock In 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.” The Automated Voice Response System provides information for up to twelve Lock In segments if the provider’s 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 Lock In. If the Member has one segment or more than one segment within the span dates the system continues the call flow at Step 41.0. If the Member has Lock In for a portion of dates or more that one segment, the system will continue at Step 42.0.
STEP 40.3 – Member Not On File For LockinIf the Member number does not exist on the Member Eligibility Master File, the system informs the user: “Member number (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 41.0 – Span Dates Lockin EligibilityIf the user enters span dates (example 01/01/96 throughout 03/31/96) for the Lock In eligibility, the system will respond as follows: “Member (MEMBER-ID) has Lock In from (FROM-DATE-OF-SVC) through (TO-DATE-OF-SVC) provider phone number is (PROV. PHONE-NUMBER or “Is not available”), provider name (PROVIDER NAME).” If the system has spoken information for the last or only Lock In segment, the system continues the call flow at Step 42.4 for Lockin Continue Menu With Name Option. If the system has information for another Lock In 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) Lock In segments remaining. To hear information for the next Lock In segment, press 1. To skip the remaining segment information, press 2.” If the user presses 1, the system resumes the call flow at step 41.0. If the user presses 2, the system resumes the call flow at Step 42.4 for Lockin Continue Menu With Name Option The system will speak 3 Lock In segments and on the 4th segment the system will provide the user with the following options: “There is/are (NUM-OF-REMAINING) Lock In segments remaining. For assistance from a Customer Service Representative, press 0. To skip the remaining Lock In 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 42.4 for Lockin Continue Menu With Name Option. If the member has no Lock In, the system will respond: “Member (MEMBER-ID) has Lock In from (FROM-DATE-OF-SVC) through (TO-DATE-OF-SVC).” The process then proceeds to Step 42.4. STEP 42.0 – Partial Lockin EligibilityIf the user enters a span date of service (example 01/01/96 through 03/31/96) and the Member has Lock In for a portion of the dates the user entered. The system will respond as follows: “Member (MEMBER-ID) has Lock In for a portion of the requested dates.” If the call is during provider representative hours, then the following message is spoken: “For assistance for 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 42.4 for Lockin Continue Menu With Name Option. 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 8 AM to 6PM except weekends and holidays. Please call back and we’ll be happy to assist you. Thank you for calling the Kentucky Voice Response System.” If the user presses 2, the system resumes the call flow at Step 42.4 for Lockin Continue Menu With Name Option. After the first time-out, the caller is disconnected with the hang-up message. STEP 42.2 – Lockin Continue MenuAt this point the system has completed the Lock In information. The caller is given the option of inquiring on another Lock In, returning to the Main Menu or transferring to a Customer Service Representative. The system prompts the user accordingly. “To inquire on another Member’s Lock In information, press 7. 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 38.0. 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 42.4 – Lockin Continue Menu With Name OptionAt this point the system has completed the Lock In information. The caller is given the option of hearing the Member’s name, inquiring on another Lock In, returning to the Main Menu or transferring to a Customer Service Representative. The system prompts the user accordingly. “To inquire on another Member’s eligibility, press 1. To inquire on another Member’s Lock-In information press 7. To hear 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 you call, you may hang up.” If the user presses 1, the system will resume call flow at Step 3.0. If the user presses 7, the system will resume call flow at Step 38.0. If the user presses 6, the system will resume call flow at Step 42.6. If the user presses *99, the system will resume call flow at Step 2.0. If the user presses 0, the call l is transferred to a Customer Service Representative.
STEP 42.6 – Member Name For LockinThe user will hear the Member’s name with the following message: “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.
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