Voice QC Scorecard

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Below you will find the questions included in the Phone QC Scorecard.
This scorecard was created and designed by Natera.
Some questions carry significant importance and sensitivity; failure to address these appropriately may result in an autofail (zero score), while others may lead to markdowns.
Make sure to utilize all available resources to provide accurate answers, take ownership of the call, and effectively resolve the caller’s issues or inquiries.
Proper HIPAA Verification
  • Did the agent confirm the callers identity by asking “Are you the patient?”
  • Did the agent verify the patient’s first and last name?
  • Did the agent verify the patient’s DOB?
  • Did the agent ask ANY of these options ? Case# – Doctor’s name – Clinic’s name – Clinic’s address
  • In the event that the caller is not the patient, did the rep follow the correct verification process?
Demographics

This is to be done with the Patient and Authorized user

No consent is needed to add or update any of the fields.
  • Did the agent verify the patient’s address?
  • Did the agent verify the patient’s phone number ?
  • Did the agent verify the patient’s email address? Complete address is needed – including any relevant details such as the apartment number, including the city, state, and zip code.
Branding
  • Did the agent open and close the call with a branding statement?
  • Did the agent answer the call within 10 seconds?
  • Did the agent advise he/she was calling on a recorded line? (Only applies for Outbound calls).
  • Did the agent include a closing statement when he/she ended the call?
  • For transferred calls: Did the agent offer additional assistance? Did the agent include a branding closing statement prior to transferring the call?
Professionalism
  • Did the agent utilize a willingness/acknowledgement statement?
  • Did the agent display courtesy by using “please” and “thank you” throughout the call?
  • Did the agent display a professional demeanor and polite behavior?
  • Overall, was the agent’s tone pleasant throughout the entire call?
  • Did the agent express empathy?
  • Did the agent ask the caller for permission to place the call on hold?
  • Did the agent thank the caller for holding upon returning to the call?
  • Did the agent offer additional assistance?
Efficiency

This is about how the agent communicated.
  • Did the agent verify the reason of the call?
  • Was the agent able to communicate with the caller efficiently?
  • Did the agent successfully probe the caller?
  • Did the agent confirm or spell back with the caller the complete insurance information, email, or mailing address provided to ensure the information is correct?
Call Management
  • Did the agent avoid silences (dead air) exceeding 20 seconds?
  • Did the agent return to the call within 2 minutes if the call was placed on hold?
  • Did the agent enter the correct case ID in the uContact manual field?

Other Questions

Question # 1
 Did the agent follow the correct process?
Question # 2
 Adhere to payment compliance by pausing recording while getting credit card information?
For Natera Escalations only
Question # 3
 If the call was transferred, did the agent transfer the call to the correct department? (if applicable)
Question # 4
 Followed the proper escalation pathways?
Question # 5
 Did the agent select the appropriate call disposition?
Question # 6
 Did the agent leave clear, concise, and accurate notes?

Reasons for Auto fails

Disclaimer for Reasons of Auto fails

These are the reasons listed for auto fails; however, this does not mean that other situations not explicitly mentioned may not also negatively impact the call and be considered a reason for an auto fail.
We maintain strict standards regarding autofails, and it is essential to follow all outlined directions. If you are ever in doubt, please reach out to your CSS or assigned QA for guidance.
HIPAA Verification
  • Missing to ask one or more required verification questions
  • Not following the proper HIPAA verification protocol
  • Asking for a piece of information but not receiving it from the patient
  • Asking for a piece of information and the information provided does not match
Processes
  • Not following the correct process for transferring to another department
  • Failing to follow the walkdown procedure
  • Not adhering to other steps outlined in the SOPs (Standard Operating Procedures)
Escalation Pathways
  • Not escalating in a timely manner (either during the call or via Syncro CRM)
  • Late submissions (hours after the interaction occurred will be considered an autofail)
  • Failing to submit a Syncro CRM escalation, regardless of the type (e.g., ZBAL, Supervisor Escalation for Demographics, SPAY, etc.) this includes not escalating demographics
Documentation
  • Failing to leave notes in all required systems (e.g., only documenting in AMD or LIMS when both are required)
  • Not leaving any notes at all
  • Documenting false information (e.g., stating that something was said, offered, or escalated when it wasn’t)

Last update by: Nina O (Oct 16, 2024)

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