Advocate Outreach and Member Callback Process
Standard Operating Procedure (SOP)
Advocate Estimated Timeframes Workflow
SOP
Advocate Commitment Handling Process SOP

Documenting Commitments in CareOne SOP
Crisis Intervention and Behavioral Health Risk Screening
Job Aid
100
What are three issues that can be resolved through outreach calls?
1. Provider outreach calls 2. Scheduling provider appointments 3. Member callbacks (commitment callbacks)
100
What is the TAT for a Provider Outreach call?
7 days
100
What it called when the plan advocate or senior plan advocate takes ownership of an issue?
A commitment
100
What software is used to access, input, document and perform maintenance on commitments?
CareOne application
100
What word should you NEVER mention on a crisis call?
Crisis
200
How long should an advocate wait when outreaching to a provider's office?
Two minutes
200
What is TAT for a pharmacy vendor call?
10 days
200
What are the three ways an advocate would communicate information to a member?
Each step in the process is communicated to provide simplified, personalized and caring service.
200
The Activity Date will always...........
auto-populate
200
What do you do if....... A potential behavioral health crisis situation is suspected, or the caller has indicated doing harm or the harm has already taken place.
The CCP may press the Mute button to alert supervisor, manager, subject matter expert (SME) or colleague to call 911.
300
True or False The advocate should make sure all parties are aware of who is on the line and to address only the subject at hand.
True
300
What is TAT for a Claims Research no on file?
30 days
300
True or False An advocate must diagnose a reason for the commitment, and select the appropriate follow-up with a member.
True
300
To retrieve the commitment in the individual que, where do you look in the CareOne database?Go to CareOne/Care Today. Under current view, select: By Task and under Task Relationship, select Owned and By Me. Note:
Go to CareOne/Care Today. Under current view, select: By Task and under Task Relationship, select Owned and By Me. Note:
300
What type of information should you obtain from the caller?
Obtain the: member's name identification number callback number.
400
True or False The advocate does not have to verify the date of birth and the address on file during call-backs.
False When collecting callback information from the member, inform the member that, for security purposes, we will ask to verify the date of birth and the address on file when we call back.
400
31 days What is TAT for Balanced Billing?
31 days
400
If an issue is unresolved and phone attempts are unsuccessful, what document should you refer to?
Commitment Escalation Process
400
What should be saved in the Task Notes?
The member ID# The call record # Commitment code TAT
400
True or False You can use your VCC to redirect your call to a crisis advocate for the states of NY/NJ
False
500
What if you are unsuccessful in reaching the provider and/or obtaining the information needed?
Advise the member that a follow-up call will be made to the provider and that three remaining attempts will be made. Create a commitment following the Advocate Commitment Handling Process SOP.
500
What is time frame for a Prior Authorization Research?
4 days
500
Name three types of issues documented in the CareOne Commitment Records?
Pharmacy issue, Claims not on file, Prior authorization research, Claims research, balance billing
500
What software should you, ALSO, document your notes on a commitment call?
CSP Facets
500
What are a specific type of words a representative can que into during a behavorial health call?Trigger Words
Trigger Words
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