Quality
How Many Possible Points for the 4 Cs section of the quality score card?
10
How many De-escalation techniques are there for you to use when de-escalating a call?
6
What symbol on the home page allows you to see your favorite Articles?
Star!
What is the Number 1 thing we must express on every call to show the member we care?
Empathy!
What are the 3 types of Authorization
Medical, Radiology, and Pharmacy
How many Points are possible for Internal Measures?
6
When De-escalating a call when is the only time you should put the member on a hard hold?
When you are conferencing in a supervisor.
What are two ways you can Manually search for Articles in Light House?
Burger Menu and Widget Menu
What is the Department ASAT goal?
80%
What are our 3 applications to look at authorizations?
What 3 Things must you say or ask the member when closing your call to receive 2 full points for Complete?
Agent recaps the call completely, asked if there was anything else, provides next steps and brands the call.
When Actively Listen to the member and they are angrily ranting and venting about their situation for several minutes, what should you do?
Wait and allow them to vent and get their issues off of their chest before trying your de-escalation techniques
Which widget will allow you to Articles about Eligibility options in Light house?
Request for Changes
How do we positively frame conversations with members?
Stay away from using Negative words and phrases and use positive alternatives
What tab in Auth Accel must you press to find Medical and Pharmacy authorizations?
Care Tab
What are the four Components of Internal Measures?
Accuracy, Legal, Documentation, Work Flow
When is the only time you can ask for Supervisor for your call?
After you have gone through all 6 De-escalation Techniques
What are the two types of Documents you will see in Light House?
Information Document and Situational Document
What two things must you acknowledge when empathizing?
The emotion and their issue
Where in RAD MD can I find the documents and letters relating to an approved or denied authorization?
See Letters Relating to Authorization Link under Authorization updates
What Actions must you complete to receive the full 6 points in Internal Measures?
Pull Up and Use appropriate DLPs, Ask for All PHI, Document all relevant notes, and Provide Accurate information to the member.
What are the 6 De-escalation techniques?
Stay Calm
Pick Tone and Words Wisely
Actively Listen
Show Empathy and Make Connection
Offer and take solutions/suggestions
NEVER put the member on HARD hold
Where can you find Webforms on Light house
On Home page under Resources
What are the 3 Types of Clarifying / Probing Questions you can ask during a call?
Close-ended, Open-ended, and Validating.
If a medical or pharmacy Authorization shows as denied in Auth Accel, where can you find the Denial letter relating to the case?
In the Communications tab underneath Correspondence.