Maestro
These three things have quick links from the Member Details Banner.
What are:
1. Update Member Address
2. Update Member Contact
3. Auxiliary Persons
You use this tab to send non-marketing materials.
What is:
Fulfillment
These three things make up compliance.
What are:
Verbal Grievances
Coverage Determinations
Organization Determinations (MIOD)
You would use this intent to view why a member's medication was denied at the pharmacy.
What is:
Claim History
The core values of UHC are made up of these 5 things.
What are:
Compassion
Integrity
Innovation
Relationships
Performance
The different sections in the summary tab are called _____?
What are:
Tiles
You would use this tab to check a members basic copay/coinsurance information.
What is:
Benefits
A decision about Part C payment or benefits. (e.g. prior authorizations, OON Doctor, DME, etc.)
What is:
An MIOD
You would utilize this intent to educate a member on their monetary position in the different coverage levels. (e.g. deductible, initial, coverage gap, catastrophic)
What is:
Coverage Stage
These two things are required on EVERY call.
What are:
Compassion and connection
You use this tab and this section to review information left on the members account by CMS, SSA, and Tier 2/3 advocates.
What are:
Recent Interactions and GPS Contact History
You would click this link in the benefits tab to view a members benefits in more detail.
What is:
Detailed Benefits
A decision about Part D payment or benefits. (e.g. prior authorization, tier exception, formulary exception, etc.)
What is:
A Coverage Determination
You would use this intent to verify if a medication is covered, and if so, what Tier it is.
What is:
Formulary Lookup
This value encompasses honoring commitments, and never compromising ethics.
What is
Integrity
Name the three things other than Name/DOB that can be used to HIPAA verify.
What are:
Complete Address
Member ID
Medicare ID
You would click this link to view a members benefits in high detail, including INN/OON copays/coinsurance, as well as any inclusions and limitations.
What is:
iBAAG
Step Therapy, Quantity Limit, and Prior Authorization all fall within this category.
Utilization Management
You would use this intent to check a members copay/coinsurance, as well as information on their deductible.
What is:
Review Rx Benefits
This value teaches us to walk in the shoes of the people we serve and those with whom we work.
What is
Compassion
You would advise a member how often of any alerts or triggers on their account? (e.g. past due, out of area, invalid phone number, etc.)
EVERY TIME there is an alert or trigger applicable to the member.
You would click this tab to view any referrals a member has on file for specialists.
What is:
Notifications
You MUST submit one or more of these ANY time the member expresses dissatisfaction with the plan or affiliated parties. (e.g. rude staff, don't like hold music, etc.)
What is:
A verbal grievance
You would open this intent ANY time the member calls in with a question, comment, or concern about OptumRx.
What is:
Rx Home Delivery
By doing this, we can make sure we are going above and beyond for our members, even when it's not the conventional thing to do.
What is:
Embracing the Gray