Transportation
What is the job aid for medicaid transportation benefits?
KM1236005
To find the formulary, where do you go in Maestro?
In pharmacy benefits intent under the formulary tab
What if my doctor has questions about covered vision benefits or services?
Members should have their eye care provider contact March Vision Care.
Are there rewards offered for pre-natal care in the Healthy First Steps Program.
There are incentives encouraging member engagement through a game interface. The program is available online only.
What is the risk question that we need to ask the member?
"I want to make sure you receive the most appropriate service. Are you concerned for your safety, hurting yourself, or someone else?"
"I want to make sure (insert member's name) gets the best help. Are you concerned for (insert member's name) safety, hurting (himself/herself), or someone else?"
What intent do we use in Maestro to quote transportation benefits?
Review Medical Benefits
Which SOP do you use to assist with authorizations?
KM1227163 Pharmacy - Authorizations
What if a member is now showing active with March Vision due to eligibility discrepancy?
Advocates should contact March Vision toll-free number (844) 706-2724
What is the web address for the Healthy First Steps Program the member will need to access?
What is the suggested scripting if a caller is demonstrating distress?
Suggested scripting: "I am right here with you. I will make sure that you get assistance."
When transportation is a covered benefit, advocates should advise members of the benefit and assist with arranging transportation when members inquire about (including but not limited to)?
PCP and specialist provider searches
Pharmacy searches
Behavioral health provider searches
When do you escalate to your supervisor during a pharmacy COB call?
If it has been more than two weeks since the original request was submitted through Macess
When would we transfer a member to march vision ?
We would not because March Vision does not speak to members
Does a member need a myuhc.com account to access the Healthy First Steps site and register?
Yes and they will be given the option at the Healthy First Steps Site to "Register Now."
If you have an emergency what is the process?
Alert a supervisor, SME, or other colleague to call 911 by flagging them down or contacting through Teams
Obtain information about the caller's situation, and share it with the colleague contacting Emergency Services.
Stay on the line with the caller until the situation is resolved.
Once the immediate situation has been addressed, keep the caller engaged in conversation, as appropriate. This may include general topics not directly related to the emergency at hand.
Caller's name
Caller's Age
Caller's current location: Address, city, and state
Caller's specific location at the site
Details of the emergency situation
If the caller is alone, are any pets loose where the caller is located, and is the caller able to open the door for Emergency Services?
We cover how many rides to and from providers offices?
Unlimited
How can you find the details for a pharmacy claim?
Through the pharmacy claim intent under Claim Details
Who do I call for authorization of vision benefits or services?
Members needing preauthorization for routine eye services and/or materials should have their eye care provider contact March Vision Care at 1-844-386-2724
What is the timeframe for earning rewards for the Healthy First Steps
Rewards can be earned throughout the pregnancy and through the baby's first 15 months of life.
What is the behavioral health crisis phone number?
800-741-6473
Transportation must be called in how many days in advance?
Advise the member to call ModivCare directly to request transportation at least three business days in advance of their appointment for a routine trips.
When assisting member with DMR, what is the process and TAT for the issue to be resolved?
Forward request to CRG via Macess. CRG requests have a 48 hour TAT to be resolved and for the member to hear back. Include the following information:
Member's name and phone number
Details of request
Name and Dosage of medication
If available DOS
Date form was mailed out
Where can members and providers go for additional guidance with vision benefits?
Members and advocates can utilize myuhc.vision.com and select Medicare plans to locate an online UHC Vision Network provider.
What is the advocate responsibility per the SOP when a member indicates they are pregnant?
Advocate will initiate a conversation about the program and ask the member if they would like to sign up.
Where can you find a behavioral health provider?
Rally