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resource navigation skills

CSC EWs must be able to efficiently navigate C-IV and the Content 7.1 system to locate key pages, items of information, documents sent and received, while interacting with the customer. It is also necessary to be familiar with accessing online Task Action Guides (TAGs), program

handbooks, the Transitional Assistance Department (TAD) Forms Catalog, C-IV User Guides, and other resources in order to resolve a caller’s issue.

CSCHB #2075 (11/15) TASK ACTION GUIDES 3-58

Customer Handling Protocol, Continued

Parts of a contact

Every contact has four major components to be handled by the CSC EW:  Opening – greeting and confirmation of caller information; this initial

contact sets the tone for the contact.

 Body – questions or issues are identified, research conducted and resolutions determined (includes preliminary C-IV data entry).  Closing – summarizes for customer how questions/issues are being

addressed, actions needed, due dates, and standard message about Interactive Voice Response (IVR)/Visual IVR (VIVR) and C4Yourself.  Wrap-up – case actions completed to the fullest extent possible based on

the TAGs and program requirements (which may result in a referral for follow-up action).

Opening the contact

The CSC EW opens the customer contact taking the actions list below:

Step Action Sample Language

1 Provides a greeting and introduction. Good morning, this is Mrs.

Jetson at the Transitional Assistance Customer Service Center, with whom am I speaking?

2 Confirms customer information.

If IVR/VIVR system… Then the EW…

Authenticates

customer, 

Confirms name.

 Confirms phone number by:

 Verifying the phone number on the C-IV Soft Phone display matches the phone number entered in C-IV, or

 Requesting the customer to confirm his/her phone number.

 Updates C-IV Contact Detail page, if necessary.

Does not authenticate customer,

 Follows the Non-Authenticated Callers Task Action Guide (TAG).  Follows steps in the block above if

caller is authenticated, or

 Explains due to confidentiality, confirmation or discussion of any case is prohibited.

 Advise caller they may call back, or go to his/her district office for further assistance.

 Offer to answer any general questions that are not case specific.

Note: If an Identity Theft Case Flag exists, further authentication

steps are required. Refer to Customer Service Center Handbook (CSCHB), Chapter 2 – Customer Service Center Communications and the Operations & Reference Handbook (ORHB), Chapter J – Journals, Tasks and Reminders for Identity Theft Case Flag procedures.

I see you’re calling from the phone number we currently have on file.

Or

May I confirm your phone number to ensure we have your most recent contact information?

I’m sorry; I am unable to assist you without proper identification. You can find your case number on any correspondence from your worker. With that you can call back, request a Personal Identification Number (PIN) through the IVR system or use the C4Yourself online application to obtain case information. However, I can answer any general

questions you may have.

3 Focuses the customer and sets the tone. How can I help you today?

CSCHB #2076 (10/15) TASK ACTION GUIDES 3-59

Customer Handling Protocol, Continued

Handling the body of the contact

The CSC EW handles the body of the customer contact taking the actions list below:

Step Action Sample Language

1 Manages irate customer contacts using:  Active listening,

 Voice modulation, and  Empathy skills.

 I understand why you are upset; let me

help you with that problem.

 I’m sorry for any confusion; I can

explain what is needed.

2 Controls the contact:

 Confirms understanding of the customer’s question or issue.  Asks questions for clarification or to

obtain more detailed information.  Responds to each question/issue

presented by the customer.

 I can assist you but I need to ask you a

few questions.

 Can you please talk a little slower so I

can be sure I understand what you need?

 Excuse me for interrupting, in order to

better assist you, let’s talk about your questions one at a time.

3 Uses proper holding technique by:  Asking permission to put the

customer on hold,

 Letting the customer know:  The reason, and

 How long he/she will be on hold, and

 Thanking the customer when re-establishing contact.

 May I put you on hold while I research

your case? It should only take a minute or two.

 Do you mind holding while I talk to my

supervisor about your case? It should not take longer than five minutes.

 Thank you for holding.

4 Uses proper transfer technique by:  Asking permission to transfer,  Letting the customer know the:

 The reason,

 The name of the person to whom they are being transferred, or  If he/she will be in a queue (on

hold) when transferred, and  Thanking the customer.

May I transfer you to another worker who can assist you with your Medi-Cal

problem? You will be on hold until a worker is available, in approximately eight minutes. Thank you for your patience.

5 Avoids long pauses by explaining what he/she is doing (data entry, generating a form, looking up a policy, etc.), or by putting the customer on hold.

 I’m mailing you forms that need to be

completed and returned within 10 days.

 I’m updating your case before we move

on to your next question.

6 Provides accurate information by utilizing all available resources.

 I can verify that information for you.  That’s a good question; I can look it up

in your case record.

7 Provides an explanation when receipt of a specific document cannot be

confirmed.

You turned in your paystubs yesterday? The office has 10 days to process your income information. If you do not get a letter or hear from us by that time, please call again.

CSCHB #2083 (01/16) TASK ACTION GUIDES 3-60

Customer Handling Protocol, Continued

Closing the contact

Call closing will be dynamic to the call and tailored to the needs of the customer.

The CSC EW closes the customer contact by taking the actions listed below:

Step Action

1 Informs the customer about actions taken by the EW to address his/her concerns.

2 Reminds the customer of potential impacting issues:  Scheduled appointments.

 Pending items, such as, reports or verifications due.  Ensuring he/she writes his/her case number on any items

returned to a district office.

 Curing penalties/non-compliance. 3 Offers additional assistance:

 Is there anything else I can help you with? or  Have I answered all of your questions today?

4 Offers IVR Voice Log In set up assistance if the customer did not authenticate using his/her voice.

5 Thanks the customer for calling. 6 Releases the call to either:

 Transfer the call to the Voice Log In set up, or

 Connect the customer to the Customer Satisfaction Survey.

Wraps-up the contact

The CSC EW wraps-up the contact by completing case actions to the fullest extent possible after the customer is off the phone, and before picking up another contact. Wrap-up includes, but is not limited to:

 C-IV data entry.

 Scheduling appointments.  Generating forms and letters.  Setting a Task for follow-up.

 E-mailing other impacted program workers or the district Contact Center Inbox.

 Journaling.

Note: See TAGs for instructions and wrap-up procedures.

References Refer to the following tools for additional information/instructions: Handbook or Tool Chapter/Topic or Title CSCHB Chapter 2 – Customer Service Center

Communications

CSCHB #2076 (10/15) TASK ACTION GUIDES 3-61

Disability Status Change With Verification

Programs The procedures in this section apply to the following programs:

 California Work Opportunity and Responsibility to Kids (CalWORKs),  CalFresh, and

 Medi-Cal.

Overview The Customer Service Center (CSC) Eligibility Worker (EW) will complete the following actions when a customer reports a change in his/her disability status:

Step Action

1 Identify the person with the disability status change.

2 Review case images for disability verification within C-IV, and:

If the case… Then…

Has a Medi-Cal Companion case,

Note: Changes in income are a Change Report Re-Evaluation (RE) for Medi-Cal.

 Begin the Change Report RE process.

 Continue to Step 3. Is a CalWORKs and/or CalFresh only case, Continue to Step 4. 3  Review the Inter-Agency Transaction (IAT) Summary page.

 Review the Determination Change, including MAGI Person Detail page for each individual listed.

 Enter the information reported in the C-IV data collection pages.  Update the Status of the Determination Change to Reviewed.

 Review the Modified Adjusted Gross Income (MAGI) eligibility status, and:

If the results are… Then…

Eligible,  Process the Change Report RE.

 Run the Eligibility Determination and Benefit Calculation (EDBC) with RE run reason.

 End-date the MAGI Determination Change case flag. Pending Eligible,  Complete an ExParte review for all unverified

information.

 Send the MAGI Medi-Cal Renewal Form (MC 216) for all information that is not e-verified and could not be found in the Ex-Parte review.

 Request MAGI, once information is received and C-IV detail pages have been updated.

Ineligible,  Send the MC 216 to allow the customer to clarify income and other eligibility factors.

 Review for eligibility to other health care programs, includes Non-MAGI Medi-Cal and Covered CA. Conditionally

Eligible,

 Process the Reported Change RE.  Run EDBC with RE run reason.

 Request needed verification using the MC 355 Process.  End-date the MAGI Determination Change case flag.  Continue to Step 6.

CSCHB #2076 (10/15) TASK ACTION GUIDES 3-62

Disability Status Change With Verification, Continued

Overview (continued)

Step Action

4 Update C-IV Detail pages including, as applicable:  Medical Condition Detail,

 Income Detail,

 Other Program Assistance Detail,  Medicare Detail, and

 Other Health Care Detail. 5 Run EDBC.

Note: Review all hyperlinks to ensure the correct benefits are issued. Option: Close call per policy.

6 Review and send Notice of Action (NOA) centrally. 7 Complete wrap-up:

 Clear any completed Task(s),

 Clear any Medi-Cal Eligibility Data System (MEDS) Alerts,  E-mail other impacted programs, and

 Journal all case actions.

References Refer to the following tools for additional information/instructions. Handbook or Tool Chapter/Topic or Title C-IV User Guides  Creating C-IV Tasks

 Income Record, Adding a New  Journal Entry, Creating

 Medical Condition, Adding

 Medicare Part B Expense, Adding a  Other Health Coverage (OHC), Adding  Other Program Assistance

 Searching for Tasks CalWORKs Policy Handbook

(CWPHB)

 Chapter 2 – Deprivation, Incapacity Deprivation

 Chapter 12 – Budgeting, Voluntary Mid- period/year Changes

CalFresh Policy Handbook (CFPHB)

Chapter 9 – Reporting, Mid-period reports Health Care Programs

Handbook (HCPHB)

 Chapter 11 – Disability  Chapter 18 – Re-Evaluations

CSCHB #2076 (10/15) TASK ACTION GUIDES 3-63

Disability Status Change Without Verification

Programs The procedures in this section apply to the following programs:

 California Work Opportunity and Responsibility to Kids (CalWORKs),  CalFresh, and

 Medi-Cal.

Overview The Customer Service Center (CSC) Eligibility Worker (EW) will complete the following actions when a customer reports a change in his/her disability status:

Step Action

1 Identify the person with the disability status change.

2 Determine if the customer is receiving and/or applied for any type of disability benefit: State Disability Insurance (SDI), Disability Insurance Benefit (DIB), Social Security Income/State Supplementary Payment (SSI/SSP), etc.

3  Request a Modified Adjusted Gross Income (MAGI) determination.  Check the Medi-Cal Eligibility Data System (MEDS), and:

If the benefit type and amount can… Then…

Be verified,  Stop here, and

 Go to Disability Status Change With Verification Task Action Guide (TAG) for instructions.

Not be verified, Continue to Step 4.

Note: Changes in income are a Change Report Re-Evaluation (RE) for Medi-Cal. 4  Complete the Medical Condition Detail page, and

 Select Pending in the Verified field drop down box.

5 Follow the chart below to determine the correct forms and action required, and: If the customer

is receiving…

Then generate the following forms in C-IV via Document Control… CalWORKs/

CalFresh,

 Medical Report (CW 61).

 Request for Verification (CW 2200).

 Request for income verification or benefit award letter, and  Refer customer to apply for unconditionally available income. Note: A CW 61 is needed for a Medi-Cal incapacity determination only and is not required for a Disability Determination Service Division (DDSD) determination.

Medi-Cal,  Medical Report (MC 61).

 Disability Determination Service Division (DDSD) packet (if applicable). The packet includes:

 Applicant’s Supplemental Statement of Facts for Medi-Cal (MC 223) for adults, or the

 MC 223 C for children under 18 years of age, and  Authorization for Release of Information (MC 220).  Medi-Cal Request for Information (MC 355), include:

 Request for income verification or benefit award letter, and  Refer customer to apply for unconditionally available income

(if applicable). Option: Close call per policy.

CSCHB #2076 (10/15) TASK ACTION GUIDES 3-64

Disability Status Change Without Verification, Continued

Overview (continued)

Step Action

6  Mail applicable forms and request for verification documents.  Enclose appropriate district office postage paid return envelope. 7 Set a Task for all impacted programs:

 Task Type: Verif Due.  Due Date: 20 calendar days.

 Long description: Enter details of the change and verification requested, if applicable.

8 Complete wrap-up:

 Clear any completed Task(s),  Complete any MEDS Alerts,

 E-mail other impacted programs, and  Journal all case actions.

References Refer to the following tools for additional information/instructions. Handbook or Tool Chapter/Topic or Title C-IV User Guides  Creating C-IV Tasks

 Journal Entry, Creating  Medical Condition, Adding  Searching for Tasks CalWORKs Policy Handbook

(CWPHB)

 Chapter 2 – Deprivation, Incapacity Deprivation

 Chapter 12 – Budgeting, Voluntary Mid-period/year Changes

CalFresh Policy Handbook (CFPHB)

Chapter 9 – Reporting, Mid-period reports Health Care Programs

Handbook (HCPHB)

 Chapter 11 – Disability  Chapter 18 – Re-Evaluations

CSCHB #2076 (10/15) TASK ACTION GUIDES 3-65

Discontinued CalFresh – Express Lane

Programs The procedures in this section apply to the following programs:  CalFresh, and

 Medi-Cal.

Overview Existing Express Lane customers who are discontinued from CalFresh are no longer Express Lane eligible and must be evaluated for ongoing Medi-Cal. Customer Service Center (CSC) Eligibility Workers (EWs) will complete the following when a discontinued CalFresh customer calls to inquire on a CalFresh case:

Step Action

1 Research Medi-Cal Eligibility Determination System (MEDS) and determine if the customer is active in Express Lane, and:

If… Then…

Yes, Continue to Step 2.

No, No further action necessary.

2 Inform the customer he/she:

 Remains eligible to Medi-Cal pending a final evaluation, and  Will be notified if additional information is needed and/or when a

determination is made.

3 Complete the Tax Household Detail page in C-IV while the customer is on the phone.

Option: Close call per policy. 4 Complete wrap-up:

 Clear any completed Task(s),  Complete any MEDS Alerts,

 E-mail other impacted programs, and  Journal all case actions.

Express Lane Express Lane customers who are within 60 days of the annual

Re-Evaluation (RE) will have a 9504 MEDS alert. These alerts will be reconciled following existing procedures for the 9504 alert.

A Burman hold will be placed on the customer’s Express Lane eligibility record if a redetermination is not made prior to the 12th month of Express Lane eligibility. Alerts will continue to generate until a determination is made. Note: If a Burman alert was generated for an Express Lane customer, check case and obtain any missing information and refer to the district for

processing.

CSCHB #2076 (10/15) TASK ACTION GUIDES 3-66

Discontinued CalFresh – Express Lane, Continued

References Refer to the following tools for additional information/instructions. Handbook or Tool Chapter/Topic or Title C-IV User Guide  Issuance Detail

 Journal Entry, Creating  Searching for Tasks California Work Opportunity and

Responsibility to Kids (CalWORKs) Policy Handbook (CWPHB)

Chapter 13 – Benefit Issuance

CalFresh Policy Handbook (CFPHB)

 Chapter 11 – Benefit Issuance  Chapter 14 – Transitional CalFresh Health Care Programs Handbook

(HCPHB)

Chapter 15 – Special Programs, Section C, Express Lane

CSCHB #2093 (06/16) TASK ACTION GUIDES 3-66.1

DMV Forms

Programs The procedures in this section apply to all Transitional Assistance Department (TAD) programs.

Overview The Customer Service Center (CSC) Eligibility Worker (EW) will complete the following actions when a customer requests a Department of Motor Vehicles (DMV) form for Reduced Fee/No Fee California (CA) Identification (ID) Cards:

Step Action

1 Identify the form the customer is requesting. They include the:

 DL 937 – Reduced Fee Identification Card Eligibility Verification, and  DL 933 – No Fee Identification Card Eligibility Verification.

2 Verify and update the customer’s address, if necessary.

Note: If the customer has no other requests, remind him/her of any document due dates.

3 Follow the chart below regarding form requests, and:

If the customer requests the form be... Then go to Step...

Picked up, 4.

Mailed, 5.

4  Schedule the customer a same day appointment per Appointment Scheduling Task Action Guide (TAG) selecting one of the Emergency appointment times.  Insert <DMV form DL 937 or DL 933 customer pick-up> in the comments

section.

 Direct the customer to his/her local office for pick-up at the scheduled appointment time.

 Go to Step 6.

Option: Close call per policy.

5  Explain to the customer the form will be mailed from his/her local district office, and:  Complete the TAD PS 03 form including the Issuance Method of Mail, and  E-mail the TAD PS 03 form to the district’s MAQ.

 Insert <DMV form DL 937 or DL 933 to be mailed> into the e-mail subject line.  Go to Step 6.

Option: Close call per policy. 6 Complete wrap-up:

 Clear any completed Task(s),  E-mail all impacted programs, and  Journal all case actions.

References Refer to the following tools for additional information/instructions: Handbook or Tool Chapter/Topic or Title Operations and Reference

Handbook (ORHB)

CSCHB #2081 (01/16) TASK ACTION GUIDES 3-67

Electronic Benefit Transfer (EBT)

Programs The procedures in this section apply to the following programs:

 California Work Opportunity and Responsibility to Kids (CalWORKs), and  CalFresh.

Overview The Customer Service Center (CSC) Eligibility Worker (EW) will complete the following actions when a customer calls to:

 Report a problem with his/her EBT card,  Request:

 A new Electronic Benefit Transaction (EBT) card, or  EBT transaction history.

Step Action

1 Verify if the customer is:

 Reporting a problem with his/her EBT card,  Requesting:

 A new EBT card, or  EBT transaction history. 2 Verify the customer’s address in C-IV.

3 Ensure the Access Type in C-IV is correct for all eligible programs.

4 Use the information in the chart below to assist the customer with his/her request if Step 2 and Step 3 do not resolve the problem:

If the customer is… Then…

Reporting a problem with his/her EBT card, Refer to C-IV User Guide(s) to resolve issue; see References block. Requesting his/her EBT transaction history, Go to Step 5.

Requesting a new EBT card, Go to Step 6.

5  Notify customer he/she may obtain his/her EBT transaction history by:  Calling the EBT Customer Service line: (877) 328-9677,

 Visiting the EBT website: www.ebt.ca.gov, or

 Requesting a C-IV printout from Transitional Assistance Department (TAD).  Complete the following steps if the customer requests a C-IV printout:

Step Action

1 Obtain the length and type of history (Cash and/or CalFresh) needed. 2  Access the Eligibility Case Summary page.

 Click the:

 EBT Account List on the Task Bar,  Account Number hyperlink, then

 EBT Card Transaction Search on the Task Bar.

 Select Cash or CalFresh from the Search By drop down menu.

 Change the From date to the desired transaction history range start date.  Click View.

3 Print and mail the EBT Card Transaction Search page(s). 4 Go to Step 7.

CSCHB #2081 (01/16) TASK ACTION GUIDES 3-68

Electronic Benefit Transfer (EBT), Continued

Overview (continued)

Step Action

6 Determine if the customer can/cannot pick up his/her EBT card in the district office, and: If the EBT

card is to be… Then…

Mailed,  Access the EBT Account Detail page.  Reissue the EBT card by:

 Clicking the Reissue button, and

 Selecting Mail in the Delivery Method drop down box.  Click Save.

 Continue to Step 7.

Picked up,  Access the EBT Account Detail page.  Reissue the EBT card by:

 Clicking the Reissue button, and

 Selecting Pickup in the Delivery Method drop down box.

In document UNIVERSIDAD TÉCNICA DE AMBATO (página 49-58)