Reporting Provider Discrepancies Quiz

What should Member Services do if a member reports an issue with provider information for California policies (200C & 360C)?

• Inform the member that the directory is wrong.

• Make outreach to the provider to confirm the information on file is correct.

• Ignore the member's report.

• Immediately update the directory without verification.

How many attempts must be made to contact a provider if they is not reached on the first attempt for a DMHC policy?

• One attempt

• Two attempts

• Three attempts

• No further attempts are needed

What should be done if a discrepancy is found within Find Care for a 200C member?

• Inform the member that the directory is wrong.

• Log the discrepancy and follow the reporting process.

• Ignore the discrepancy.

• Immediately correct the discrepancy without verification.

What information must be included in the email when reporting a provider issue for CA?

• Member ID, Member Contact Information, Date of provider outreach, Name of person spoken to, Specific details of the issue, Name of digital tool involved

• Only the Member ID

• Only the Name of the person spoken to

• Only the Date of provider outreach

What should be done if the CA provider confirms there is a discrepancy?

• Ignore the confirmation.

• Document the provider discrepancy and submit.

• Tell the member the provider is wrong.

• Do nothing and wait for further instructions.

What is the first step when reporting a discrepancy for CA 200C members?

• Select the provider and check the Report Discrepancy box.

• Immediately send an email to the provider.

• Update the directory without verification.

• Ignore the discrepancy.

What should be done if the CA provider is not available at the time of outreach for a 200c policy?

• Make a second attempt to contact the provider.

• Ignore the provider and move on.

• Update the directory without verification.

• Inform the member that the provider is unavailable.

What should be included in the notes when documenting a provider discrepancy in the provider task for a DMHC policy?

• Date the provider outreach was made, Name of the person spoken to, Specific details of the issue, Name of digital tool involved

• Only the Date of provider outreach

• Only the Name of the person spoken to

• Only the Specific details of the issue

What is the suggested scripting to the CA member if the provider cannot be reached during the call?

• "The provider is unavailable, please try again later."

• "We were unable to reach the provider to confirm the information that has been provided. We will continue attempting to reach the provider to validate the information provided."

• "The provider's information is incorrect, please find another provider."

• "We have updated the directory without verification."

Tags

CCSS.RI.4.5

CCSS.RI.5.3

CCSS.RI.5.5

CCSS.RI.6.3

CCSS.RI.6.5

What should be documented in your exempt grievance task when you have submitted a provider discrepancy?

• Ignore the confirmation and update the directory.

• Access to Care issue

• Inform the member that the provider is wrong.

• Do nothing and wait for further instructions.