SMST QA Reviews
Name: 


A red asterisk (*) indicates required questions.

  1. CCR PeopleSafe ID*


  1. CCR ZID*


  1. CCR First Name*


  1. CCR Last Name*


  1. CCR Location*
    Houston
    Madison
    Raleigh


  1. Date of call (MM/DD/YY) and Time of Call HH:MM*


  1. Member HICN / MBI*


  1. Call Type*
    Address Change
    Out of Area (OOA)
    Disenrollment
    Cancellation of Enrollment
    Cancellation of Disenrollment
    TRC127
    LEP
    Other


  1. Was the call handled correctly (followed the proper processes and provided accurate and complete information)*
    Yes
    No


  1. Was the appropriate Work Instruction used*
    Yes
    No


  1. If applicable, was the Disenrollment/Cancellation Call Handling Tool used?*
    Yes
    No
    N/A


  1. If applicable, was the RxEnroll Care Tool used?*
    Yes
    No
    N/A


  1. Observations / Comments regarding the call, including what caused them to fail.*





Guy Macdonald