Customer Contact Center Food Stamp/Family Medicaid Phase II ...

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Call Center FS/FM SUCCESS PG October 24, 2007 Documentation MACROS/Quick Scripts UPDATE REMARKS - REMA REMA XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX TPL Medicaid XXXXXXXXXXXXXXXX Date SGCC Worked Case: 11/3/2006 2:07:41 PM Method of Contact ( )Phone ( )FAX ( )Mail ( )Other Contact's Name/Source: AU member with Third Party Insurance: Is member receiving or financially responsible in MA case: Insurance company Name,Address and Phone #: Policy holder: Policy #: Form 285 sent to DMA on: Remarks: Enter Name, Load and Tel # XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX PM-40
Call Center FS/FM SUCCESS PG October 24, 2007 Documentation MACROS/Quick Scripts UPDATE REMARKS - REMA REMA XXXXXXXXXXXXXXXXXXXXXXXXXXXXX VEHICLE RESOURCE XXXXXXXXXXXXXXXXX DATE SGCC WORKED CASE: 11/3/2006 2:09:43 PM METHOD OF CONTACT ( )PHONE ( )FAX ( )MAIL ( )OTHER CONTACT'S NAME/SOURCE: VEHICLE YEAR,MAKE AND MODEL: VEHICLE USED TO TRASPORT DISABLED/INCAPACITATED AU MEMBER: OWNED/LEASED VEHICLE: JOINT OWNERSHIP ( )YES ( )NO JOINT OWNER'S NAME: # OF VEHICLES IN AU: FMV: VERIF SOURCE USED FOR FMV: AMOUNT OWED: CALCULATION OF VEHICLE RES[1ST VEHICLE] FMV-$4650: *****ALL OTHER VEHICLES,COUNT EV[FMV-AMT OWED]: VEHICLE EXCLUDED ( )YES ( )NO INCLUDED IN BANKRUPTCY ( )YES ( )NO EXPLAIN: TYPE OF VERIFICATION: Form C173 Sent: Due Date: Remarks: Enter Name, Load and Tel # XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX PM-41
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Customer Contact Center Food Stamp/Family Medicaid Phase II ...

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