PBQ Chatbot (Benefits)

What is the purpose of the 5 W's of Benefits?

• To calculate the member's premium

• To find the best provider for the member

• To determine the cost of services

• To ensure the most appropriate benefits are quoted to the member

Which question is NOT part of the 'Who' category?

• Why is the service being performed?

• Who is providing the service?

• What is the provider’s specialty?

• Is the provider INN or OON?

Tags

CCSS.RI.1.4

CCSS.RI.2.1

CCSS.RI.3.1

CCSS.RL.2.1

CCSS.RL.3.1

What should you do if the member is unsure about the location of the service?

• Ask the member to confirm later

• Quote benefits for all available places of service

• Choose the most common location

• Ignore the location and proceed

What does the PBQ Agent Assist Chatbot NOT include in its details?

• Visit limits

• Service level exclusions

• Cost-shares

• Mandate requirements

What should you do if you recognize a discrepancy in the PBQ Chatbot information?

• Confirm with the EOC or FOBS

• Re-run the search

• Report the issue to Frances Nolen or create a SNOW ticket

• Ignore it

What is the correct action after reviewing the benefit with the member?

• Ignore the reviewed box

• Close the CBQ and check the Reviewed Box

• Reopen the chatbot

• Start a new search

What does the 'Why' category help determine?

• The location of the service

• The provider's specialty

• The reason for seeking treatment

• The cost of the service

Per DMHC (200C) what must be done when quoting benefits to the member?

• Read the script verbatim in the PBQ chatbot

• Quote in-network benefits

• Use the general benefit quote option

• Quote from the FOBS

When quoting benefits, do you need to confirm the information from the PBQ Chatbot with the EOC or FOBS?

• No, the benefits in the PBQ Chatbot should be reviewed with confidence

• Yes, you should confirm the information

• None of these

• You should always check all resources when giving a benefit quote

A member calls and advise that her wellness exam should be covered at 100%. What step needs to be done per DMHC guidelines?

• Pull the eoc and quote the Wellness exam benefit.

• Quote the benefit from memory

• Open the benefit & cost task. Search the benefit using the PBQ Chatbot advising the findings to the member in detail.

• Advise all HCR benefits are covered at a 100%