Authorizations Call Flow

Authorizations Call Flow

Call Flow

Call Flow: Entering Report & Gathering Information

Call Opening & SP Verification

“Thank you for calling Authorizations. My name is <Agent Name>. To whom do I have the pleasure of speaking with?”

“Okay, great <Caller Name>, and what company are you calling from?”

  1. Sears Calls:
    1. Ask for the Service Order Number of the Customer Phone Number to pull information up in the system.
    2. Ask for their Tech ID Number (Sears Garage Techs many not have a Tech ID).
  1. All Other Providers:
    1. Ask for the Customer Phone Number.
    2. Confirm the last few digits of the Service Job Number.

Customer Verification

“Are you calling in regard to <Customer Name> at <Street Address>?”

“Are you providing a report and are you currently at the home?”

  1. IF YES: Move forward

  1. IF NO: “Who was the tech at the home?”

“Is this under your limit?”

  1. IF YES: Find out why they are calling

  1. IF NO: Move forward

Calls supported by Authorizations:

  1. Tech is in the home, needs immediate approval over their authorized limit and can complete the repair same day.
  1. Potential Denials (All potential denials under $300 are covered regardless of coverage).
  1. Repairs with Non-Covered Charges.
  1. Replacements
  1. Recalls
  1. Emergency/Medical Emergency

If outside of these reasons, document the reason and educate the Service Provider on utilizing CinchPro. Assist the provider with what they need even if it’s not a reason listed above and capture this in your Autho Call Tracker so we can coach the Service Provider.

“When was the Service Call?”

Product Verification

Ask all of the following questions to gather information about the product:

  1. “What item are you working on?”
    1. If this is an HVAC call and you are not an HVAC Tech Agent, remind the SP that they should follow the proper prompts when calling in, then cold transfer them to the HVAC Tech Agent Queue (69300).

  2. “Can I have the Model and Serial Number?”
    1. Verify that the model/serial number is valid by utilizing Google and the Authorizations SharePoint Page.
    2. Verify that the model number matches what the product is.
      1. Example: Model Number shows Heat Pump, but the Product Line shows Straight Cool.
    3. Update the Product Line in the Service Order if not correct.
  3. “What’s the name brand and who is the manufacturer?”
    1. Verify by entering model number in Google or utilizing other resources.

  4. Where is it located? What area does it service? How many units in home?”
    1. Example: 1 of 2 systems, services upstairs only.
    2. Probing Questions (HVAC):
      1. “Is this a Split System or Package Unit?”
      2. “Is it located on the ground or on the roof?”
      3. “Is it a Condenser with an Air Handler or a Condenser with a Coils and Furnace?”

  5. “What’s the age and condition?”
    1. Utilize Google or the Authorizations SharePoint Page for age determination of different products.

  6. “I need some additional information on that unit <Attributes>.”
    1. Pull up the Attributes Reference Guide, locate the correct unit, and ask for the specific attributes.

  7. “Thank you for this information <Caller Name>.”

Part Failure Information

Ask all of the following questions to gather the diagnostic information:

  1. “What failed?”
    1. Compressor, Fuse, Control Board, etc.
    2. The technician may advise the part and how it failed in one sentence. Be sure to use your active listening skills and pay attention to the failure so you don’t have to ask again.
      1. Example: “The motor seized.” Instead of asking how it failed (seized), just enter the information since you were already advised.

  2. “What was the failure?”
    1. Shorted, Seized, Broken, Leaking, etc.

  3. “What caused the failure?”
    1. Normal Wear & Tear, Freeze Damage, Surge, Missing, etc.

  4. “Are there any additional failures for this?”

  5. “Are you able to supply the part or replacement?”
    1. If Yes: Proceed to Fees & Pricing.
    2. If No: Capture all part information and attempt to locate through Shopping Cart and Marcone or send to Research. Skip to question #3 in Fees & Pricing.

Fees & Pricing

Check the Service Order to verify if the Deductible was collected by us during initiations. If it was collected, skip to question #2.

Ask all of the following questions to gather the SP’s pricing information:

  1. "Did you collect the full deductible? How much was collected?”

  2. “What is your cost for the <Part Name>?”
    1. Capture all part information.
      1. Be sure to utilize your resources to verify the part number is valid.
    2. Obtain pricing for each individual part.

  3. “How long will it take to repair/replace?”
    1. Labor Hours can be in quarter increments in the claim (1.25 Hours, 2.50 Hours, etc.)

  4. “What is your Service Call Fee or Flat Rate Amount?”
    1. If the Service Provider is flat rate, be sure to verify by viewing their profile.

  5. “What is your Labor Rate?”

  6. “Are there any Non-Covered Charges?
    1. Typically, Water Heaters and HVAC repair/replacement jobs have non-covered charges, obtain at this time.

  7. Verify Travel and Additional Diagnostic with the Service Provider, ONLY if documented in the notes, do not prompt them.

HOLD

“Thank you for this information. I will be placing you on a brief hold while I update the account and verify coverage.” (Wait on Acknowledgement) “Thank you.”

  1. Utilize TIMX SCM to pull up the Warranty Terms & Conditions.
  1. Transfer your information into ServiceBench.
    1. Update Service Type if you are giving pre-authorization
      1. Repair
      2. Replacement
        Replacement Deductible-SP to Collect
    2. Enter the Service Date
      1. The date the tech was at the home for the initial diagnosis.
    3. Update Sub-Status if you are not sending to research
      1. Service Report Submitted
      2. Job Not Covered
      3. Awaiting Diagnosis
    4. Update the Service Explanation
      1. Click Save on the Service Job once this is entered in order to timestamp the exact time the report was submitted.
      2. This is needed for reporting purposes.
    5. Enter each Part in the Part Lines regardless of coverage.

Review:

  1. Contract History
    1. Review the full history of the Customers Address

  2. Product History
    1. Review the full history of the specific Product

  3. Contract and Cap Limits
    1. Review the Terms & Conditions for Cap Limits
    2. Review the Entitlements IF the Product Line was entered correctly

Potential Denials:

  1. Contact the Decision Desk for all Potential Denials.
    1. Prior to contacting, be sure to have the full Service Report and a decision on how you want to proceed with the Service Job.

Calculate:

  1. CHS Liability
    1. Vendor Payable: Service Call + Additional Diagnostic + Parts + Labor + PUP (if applicable) – Deductible

  2. Customer Liability
    1. Deductible
    2. Not Covered Parts & Labor
    3. Non-Covered Charges

Additional Questions / Negotiations

While on hold, you may have reviewed the job with the Decision Desk, Autho Specialist, or a Supervisor and might have been asked to get additional information or to push back on pricing.

“Thank you for holding <Caller Name>, I was able to review this and would like to go over <Pricing/Questions>.”

Update the Service Job where applicable and move on to provide the Service Job Status to the caller.

Provide Job Status to Technician

If Approving, advise what is owed:

  1. “Total Payable is <Amount>. How soon are you able to complete repairs?”
  1. Document when the Service Provider will be able to complete repairs.

If Partially Approving, advise what’s owed and what is covered:

  1. "We will be addressing the <Covered Part & Labor for Covered Repairs>. The <Not Covered Part> is not addressed under the policy. This will be a C.O.D. for the customer. We will reach out to update them. The total we will owe you is <Covered Amount>.”

If Ineligible for Coverage, advise of labor to date amount (unless California/Iowa, which needs to be emailed):

  1. “The <Part/Equipment> will not be addressed because <Part/Failure> is not covered under the policy. Above the deductible, total payable is <Amount> for your labor to date.”
  1. Create and Approve Claim, update the Sub-Status to Job Not Covered, update all not covered parts on the part line to COD Part, and complete the job (unless California/Iowa, which needs to be emailed/reviewed first).

If Sending to Research:

  1. “I have all the information I need. I am going to send the parts/equipment over to Research.”

Comment

  1. Use the Authorizations Note Template and enter it in the Comments section.
  1. Confirm the Service Explanation is correct, edit if needed.

Create Claim

Adjudication of the Job:

  1. Advise tech that they can review their claim at any time through ServiceBench or CinchPro.
  1. If the tech wants to hold for the claim number confirmation, do this step before your comments to get the tech off your line as soon as possible.
  1. Authorizations Agents are not required to create a claim if it’s a National Account (Sears, LG, GE, etc.) or if the job is being sent to research.
  1. If needed, the agent should complete the Service Job if it’s not a National Account and the tech is unable to use CinchPro.

Call Closing

“Is there anything else I can assist you with? Thank you for calling Authorizations.”

General Guidelines

Silent Call Procedure

When there is no response from the caller at the start of the interaction:
  1. Repeat the greeting 3 times.
  2. If there is still no response from the caller, say “no response from the caller, disconnecting call.”
  3. Disconnect the call.

Excessive Hold Procedure

When a Service Provider places you on hold for longer than 3 minutes:
  1. Place caller on hold, then call the Service Provider using the numbers provided in the system to see if they still need assistance.
    1. If the technician answers and advises they no longer require assistance, follow the call closing procedures.
    2. If no response:
      1. Hang up and switch back to the call on hold
      2. Say "hold over 3 minutes"
      3. Place the call back into the queue
Alert
If you are on hold waiting for the SP to get information that you requested, remain on the line until they return. The 4-minute maximum only applies to unanticipated holds initiated by the SP.

Dropped Call Procedure

When you're in the middle of a call and the call drops as an unintentional disconnect:
  1. Attempt to call the Service Provider back using all available numbers.
  2. If unable to get in touch with:
    1. The Technician: Call the office and ask for them to be connected or to have them call back into Authorization. Document what transpired.
    2. The Customer: Leave a message to call back into Customer Service. Document what transpired.
Alert
When a call is disconnected intentionally you don't call them back to avoid escalation, advise your Supervisor and document the job.

Multiple Job Call Procedure

  1. When a Service Provider calls into Authorizations with multiple jobs for the same customer, you're required to take all Service Reports.
  2. When a Service Provider calls into Authorizations with multiple jobs for different customers, you are only required to take up to 2 jobs and then offer to place the Service Provider back into the queue.
  3. For all Cinch Fix'd Service Providers, the authorizer can take up to 4 jobs prior to placing them back into the queue.



    • Related Articles

    • Authorizations Outbound Call Script

      An outbound call is required when: A job has been denied/partially denied. Unless CA/IA and NOT an emergency Unintentional disconnect by agent. Unintentional disconnect by caller. Medical Emergency/High Risk updates are available. Non-Covered Charges ...
    • Customer Service Call Flow

      Agents are not required to give out their last names. If asked, please respond with the following: "Thank you for asking. I can give you my First Name as well as my Employee ID." (Employee ID=Agent Extension) If customer asks why, advise this is for ...
    • Tier 2 Call Flow

      Agents are not required to give out their last names. If asked, please respond with the following: "Thank you for asking. I can give you my First Name as well as my Employee ID." (Employee ID = CXone Agent ID) If customer asks why, advise this is for ...
    • Authorizations Note Templates

      Notation is extremely important for the Authorizations Process. Writing understandable and clear notes is required to help the agents that come behind you know what the next steps for the job are. Authorizations use Note Templates to make it easier ...
    • Customer and Service Provider Conference: Reassignment

      During a Reassignment, when calling out to a provider from Extended Zip/Service Locator or calling for an Emergency/Medical Emergency service request we must attempt to Conference the Customer with the Service Provider to schedule and capture the ...