Initial Outreach
This type of verification is required when calling an enrollee.
3 Point HIPAA Verification
When opening a case, this episode class should be assigned to indicate the enrollee has agreed to case management but is in the process of completing the initial assessment and care plan.
Episode Class- 0.
What is the determining factor between a successful call and an unsuccessful call?
Speaking with the intended party
This is the timeframe for outreaching an enrollee to conduct the Postpartum survey
Within 2 weeks
These are the three Doula vendors contracted with AmeriHealth Caritas DC
Mamatoto
BirthingKind
Womb of Creation
These 3 identifiers are required for 3-point HIPPAA verification.
- First and Last Name
- Date of Birth
- Address or Member ID number
When an enrollee is assigned this episode class, the CM will schedule an outreach between >3weeks to 6 weeks
Episode Class C- Engaged
This is the set timeframe for documentation of a note after a call
24 hours
What are the next steps according to the EPDS policy when a care connector completes an EPDS screening with an enrollee and notes a final score of 11 or more?
Warm transfer to a CM, Supervisor or Director.
This stakeholder provides Safe Sleep training to ACDC staff and provides us with pack n' play's to distribute to enrollees who have completed the safe sleep class
DOH/ DC Health
The caller must notify the enrollee about this practice related to quality assurance.
Call monitoring
Which two MEMBER classes can be assigned to an enrollee.
"In process" or "Engaged"
List at least 2 conditions that could qualify for EPISODE class A- contact every 1-2 weeks
Preterm Delivery
Multiple Gestation
Cervical Incompetence
Diabetes
HTN
IP related to current pregnanct
After 2 unsuccessful call attempts to an enrollee who is 3 weeks postpartum, the CM/CC should use this form of outreach as their next step.
A letter
Who is the newest hire on the Bright Start Team
Tamara Irvin
This is the time frame within which a referral for high-risk pregnancy should be outreach once received.
1-3 business days.
When completing the pregnancy care plan, what mandatory goal should always be included
"Complete Bright Start High Risk Pathway"
True or False: Once established, the episode class can not be changed based on the case manager's judgement
False
List at least 3 key touch points to address with the enrollee during the initial postpartum outreach
PP appointment
Signs and Symptoms of PP PPD
Peds appt for baby
ESA office
WIC
PCP
Which Bright Start Associate has been with AmeriHealth the longest?
Lakia
Selam
Clara
This referral type indicates an outreach must be complete within 1-3 business days.
High Risk Pregnancy, Inpatient Admit, and Urgent Referrals.
What is the estimated length of engagement for a High Risk Pregnancy?
6-9 months
These 6 assessments MUST be attempted during the initial intake of a high risk enrollee.
-Maternity Survey
- PHQ2 and/or PHQ9
-5P's Prenatal Substance Abuse
-Referrals and Interventions
-Keys to your care
-SOGI
-SDOH
This is the timeframe in which an enrollee should have a postpartum visit with their OB/ PCP
7-84 days after delivery ( 1 week - 12 weeks)
Name all 16 Bright Start CM/CC's
CC's: Renata, Yolanda, Jamesse, Selam, Terita, LaTara, Clara, Lakia
CM's: Rahel, Tamara, Jenny, Ola, Deidre, Jackie, Nia, Veronica