Welcome Call Outreach Interaction Scripter Guidelines

Last Revised: November 16, 2023

LOB(S): CCP, DNSP

Purpose
To assist agents with facilitating Outbound and Inbound Welcome Back calls as well as provide
guidance for documenting calls in Interaction Scripter.
Call Flow
• Greet Member
• Privacy Statement & HIPAA Verification
• Value, Pharmacy Benefit
• Spendables Card
• Digital Tools, Nurse Advice Line, Zero Dollar Copay Education
• Nutritional Counseling, Fitness, Annual Wellness Education
• Closing
• Document Appropriately in Scripter & CAREConnects/OMNI
Important Notes
HRA’s will not be HRA scripting and Action codes will be present within the dialer, however
completed on this call agents should skip this portion of the script as HRAs will not be
completed during this interaction.
Temperature Check Agents are required to document one of the three-member temperature
Action Codes action code based on how you felt the member felt at the end of the call
interaction.
Member Temperature – Member Satisfied
Member Temperature – Member Neutral
Member Temperature – Member Dissatisfied

CSAT Agents are required to offer CSAT survey at the end of inbound calls.

"If you would like to take the survey and would like to provide feedback on how I
assisted you today, please stay on the line. Thank you for calling <Brand Name>, your
partner in quality healthcare, have a great day."
CAREConnects

1
Documenting in CAREConnects
• Call Driver: Other
• 1st Level Reason code: Outbound Campaign, OUTCAM
• 2nd Level Reason code: Outbound Member Services Follow up, OBMSF
• 3rd Level Reason: MSCUN – MSC Unsuccessful or MSCSC – MSC Successful
• Action Code: CSEDUC- Educated Caller or CSLMM – Left Message

Documenting in OMNI – Please see Call Tool

Campaign Outbound Team Team Code Callback Number

STARCare Welcome Back SC 1-855-444-3219

Welcome_Back Results Welcome Back RS 1-844-901-3787

TP Welcome Back TP 1-844-916-3533

CNC_Welcome_Back STARCare Welcome Back SC 1-844-901-3794

Call Documentation Signature:

<Call Interaction ID> Outbound call to member at <XXX-XXX-XXXX> from <Team Code> for
welcome back campaign. Member indicated that <Clearly document all actions taken and
information discussed on the call>

Dialing Mode
Managed Preview
Agents will have 60 seconds to preview the call prior to the dialer dialing the lead.

If Call is Placed and Agents should use best practice of checking in with the members and
Should Not Have Been offering any additional assistance.
Disposition Definitions
BusySignal Received a busy signal
CallbackRequested The member requested to receive a callback at a specific date/time and
callback time was scheduled
CallComplete The goal of the call was completed
Deceased The member has passed away
DisconnectedCall The phone rang, but the call dropped prior to anyone answering the
phone
DoNotCall The member requested to be placed on a DNC list; this does not put the
member on a permanent DNC list, only prevents additional call for the
same campaign
2
Emergency Disconnect Emergency situation arises and requires the call to be disconnected
immediately (by agent or member)
FaxModem Received a fax machine
HungUp The member hung up
ImmediateCallback Used to callback member immediately after a disconnected call
LeftMessage ThirdParty The member was not available and message was left with 3rd party
Manual Callback Used to callback member after inbound call
Request
NoAnswer The phone rang continuously
NotAttempted The member is no longer eligible for campaign
NotAttempted Termed The member is terminated and agent does not attempt outreach
NotInterested The member declined speaking to us and is not interested in the program
call.
RefusedCall The member refused to verify HIPAA or be recorded
TelcoAdvisory TriTone “the number you have dialed is disconnected or no longer in service”
TransferredCall The call was transferred to another department and campaign was not
addressed
Voicemail Voicemail was left for the member
VoicemailMessageNotL The voicemail stated that the mailbox was full or not setup
eft
WrongNumber The call was the answered and answering party stated it does not belong
to the member
Action Code Definitions
Annual Wellness Agent attempted to schedule Annual Wellness visit, however the member
Appointment Declined declined.
by Member
Annual Wellness Agent was able to successfully schedule the Annual Wellness visit for the
Appointment Made member.

Annual Wellness – Agent attempted to schedule Annual Wellness visit, but the member
Member Already had already completed the screening.
Recent Appointment
Annual Wellness – Agent attempted to schedule Annual Wellness visit. Member explained
Member Already has they already scheduled the appointment, and it is upcoming.
Upcoming Appointment
Annual Wellness – Agent attempted to schedule the Annual Wellness visit, however the
Unable to providers office was unavailable.
Reach/Contact Office
Annual Wellness – Agent explained the importance of an Annual Wellness visit, but was
Education Only (After unable to schedule due to the call being after hours.
Hours)
Claim Info Reviewed The agent reviewed claim info with the member
Community Advocacy Agent provided the Community Advocacy to the member
Provided
Disenrollment Process The agent provided the disenrollment process to member
Provided
Disenrollment The member requested to disenrollment, but agent retained member
Requested- Retained
3
Grievance Filed That agent filed a grievance for the member
PCP Changed/Updated The agent updated the members PCP
PCP Correct The members PCP on file was correct at the time of the call
PCP Update Declined The member declined to update their PCP at this time
PPO Member – The member is currently on a PPO plan and their PCP is not in our
Member seeing OON network.
PCP
Member refused/hung Member Refused language line assistance or hung up while contacting
up on language line the language line. ** Agent should attempt to call the member back with
assistance the interpreter on the line
Phone Translation The translation line was used during the call.
Services Used
Transferred to different The agent transfers the member to a different department
department
Contact Information Agent updated the members contact information (email, phone number,
Updated etc.) during the call.
Member Temperature - Agent feels that the member was satisfied with us calling.
Member Satisfied
Member Temperature - Agent feels the member was not satisfied nor dissatisfied with us calling
Member Neutral
Member Temperature - Agent feels the member was annoyed or dissatisfied with us calling
Member Dissatisfied
Data Captures
Section 12: Do you Please ask the member if they have internet and then mark ‘yes’ or ‘no’.
have access to the
internet?
Section 12A: Would you Please ask the member if they would like more information pertaining to
like to hear more about Telehealth services such as Teladoc and the 24-hour Nurse Advice Line.
these remote health
benefits?
Section 13: Would you Please ask the member if they would be interested in hearing more about
be interested in hearing the nutritional counseling benefit.
more about this
benefit?
Section 14: How helpful Please ask the member how helpful the call was with 1 being the least
was the call on a scale helpful and 6 being the most helpful. Note: This is referring to the
of 1-6? material discussed on the call not how well the call was handled.
Section 14: Which Please ask the member which benefit they are most interested in
benefits talked about between the options listed.
today are you most
interested in?
Section 14: Any Please ask the member if they have any suggestions and type them out
suggestions to make in the text box.
you health care
coverage easier to use?