TATs
What is the process for completing IHL calls?
2 attempts on different days and times within 7 calendar days of task to CM
note: if call is already scheduled with engaged member, CM discretion is used whether to call sooner
Initial Research needs to be completed by when?
Complete research within 3 calendar days of assignment.
Best practice: complete research on day assigned
Follow up Outreaches should be completed?
2 attempts on different days and times within 14 calendar days from assign date.
NOTE: f/u calls should be completed at least every 2 weeks until initial assessments are completed
What is the TAT time for MD consult for our complex and non complex engagements?
within 30 calendar days of engagement for complex and within 60 days of engagement for non complex
note: all MD consults can be completed earlier per nursing judgement
Discharge planning outreach should be completed by when? How many attempts are made weekly?
to be completed within 1 calendar day of PDC/LOS opportunity or manual referral. Attempt 2 facility DCP calls per week at minimum.
Note: additional calls may be needed based upon needs/barriers to discharge presented.
Pre-Admission outreach should be completed in what cadence?
follow complex outreach cadence for initial outreach which is 2 calls in 14 calendar days with first outreach being within 7 calendar days of assignment.
PSE Outreach by CM needs to be completed when?
follow complex outreach cadence for initial outreach - two attempts on different days and times within 17 calendar days from assign date, with first outreach within 7 calendar days of case assignment.
Provider outreaches should be completed for complex cases by?
2 attempts required - may be call and/or fax within 14 calendar days of engagement OR 2nd UTR attempt.
Note: Complex opportunities that require provider outreach regardless of engagement status: RAP, RAP with readmission, HCC per workflow and PDC
What is the TAT for provider outreaches with RAP cases?
2 attempts within 14 calendar days of RAP opp ID.
Note: if member unexpectedly readmits while RAP DGA status is open, contact provider by 7 calendar days of CM receipt of notification.
What is the call cadence for RAP cases?
2 attempts within 7 calendar days of discharge date. First outreach within 3 calendar days of discharge date and second within 7 calendar days.
Note: Day of Discharge is day 0
Follow up should be completed at least biweekly or sooner if needed for first 30 calendar days of engagements until CM triage assessment is completed.
When does the IPCC need completed?
Complete within 1 calendar day of PDC/LOS opportunity.
note: attempt IPCC prior to discharge planning call to have a better idea of member needs
Level one or Clinically Urgent Care considerations follow what call cadence?
two attempts on different days and times within 14 calendar days from assign date with the first outreach with 7 calendar days of case assignment.
Virtual Primary Care Referrals need completed by?
2 outreaches need completed within 7 calendar days of receiving case.
When do the MD consults need to be completed for RAP cases?
As soon as needed per nursing judgement, but no later than 7 calendar days of RAP opportunity identification.
NOTE: unplanned inpatient acute hospital readmission while RAP DGA is open status - the CM will submit MD consults no later than 7 calendar days.
When does the past medication discussion need to be completed by for our complex cases?
Documented in notes with at least medication name and due by completion of CM Triage