Compliance
Throughout reading the consents, the ES would interject and adlib additional information that was not within the consents verbaige.
What is best practice when verbally consenting a member?
What is read the consents verbatim as they are written in the enrollment assessment.
The ES captured PII while speaking to the member, what two places does this information need to go?
The term " Community Health Workers" is used for what contracting entity? The term "Resource Specialists" is used for what contracting entity?
What is Aetna and Humana
Verifying PII for a member includes what three things and do you need to include the following: apartment/space number, street, drive, ave, circle which are called street suffixes?
What is the member's full first and last name, DOB and complete home address. Yes, you do need to have the member include the apartment/space number and the street suffixes.
The workflow process for a callback is what?
Keep the enrollment assessment in progress assigned to you 2) schedule a callback in TB 3)make sure the enrollment assessment is assigned to the scheduled callback
The use of the term "benefits" when calling an Aetna member is not best practice or scripting, Aetna prefers to have TC refer to their members as what?
Eligible members
When should the RLD be mentioned when making an OB call?
What is utilize the script and RLD is right after "I was calling to introduce myself and TC to you because, as I mentioned, we work closely with Aetna. Before I begin, I need to leyou k now that this call may be monitored and recorded for quality and training purposes"
What is the question that needs to be asked verbatim from the social needs section?
What is Do you have access to food for the next 1-2 days?
This term refers to TCOP, and describes the specific information an ES uses when speaking with a member, including when in the conversation it should mentioned.
TCOP-Thymecare Oncology Practice, use the medical details on the left handside panel only after verifying the members complete first and last name, use this information while going through the introduction.
What is the correct response from a member when they are agreeing to consents?
What is "Yes or No"
What is another question that has to be asked verbatim according to the micro learnings and the enrollment Form Question Guidance?
What is "Do you know what type of cancer you have or had?
Member states: Who is Thymecare and what do you do? A suggestion was placed in the team chat yesterday...
Great question, Thymecare is a care navigation team provided to you through our partnership with (Health Plan) and we offer Eligible members extra support. With Thyme care, you get access to our program that will support you.... (example for Aetna)
If you get this question after verifying PII then you can say.."Great question, Thymecare is a cancer care navigation team with oncology nurses and community health workers available to you 24/7 and not additional cost...
The steps to offering consents is...
Text, email then verbally. Only send mail consents when the member ask for it.
What questions from the Caregiver & Support System section need to be asked verbatim according to the Micro learnings and the Enrollment Form Question Guidance and why?
The member mentions "I am doing really well and I don't need these services". The NCQA reframing response would be....you can use any of the three suggestions.
That is great to hear you are doing well and this is actually a great time to enroll and have the intimal conversation with one of our nurses, because we can establish a base line of what your good looks like. So, the the evet you do need us when you call we have that information and can assist you even more effectively. Let's go ahead and get you enrolled so your services are readily available.