HIPAA, Handle It!
This federal law protects member health information and privacy.
What is HIPAA?
When a member wants a new coach, those requests are routed here.
What is the Coach Manager queue?
Members should submit refill requests through this location.
What is the refill request form in the Calibrate app?
This should always be your last step before sending a macro response.
What is proofreading for personalization, spelling and grammar? (any and all of these are acceptable)
Before escalating an enrollment issue, you must verify this link.
What is the Join Now Flow (JNF) link?
Discussing or sharing member information with a family member is covered in this SOP.
What is Family Members and HIPAA?
This group handles claims blocks at the pharmacy.
What is Care Coordinator Clinical?
Before responding to a refill inquiry, you must check this section in Calibrate Central.
What is Medications?
This macro is sent when an Optum enterprise member requests cancellation.
What is /Member Initiated Disenrollment Confirmation Optum or NFI?
New insurance records may take approximately this long to appear in eligibility files.
What is one week?
PHI should not be sent via this method unless a HIPAA form is on file.
What is email?
Requests for scale replacement after completing Withings troubleshooting are sent here.
What is Care Coordinator Experience?
This is where you'd click in Calibrate Central if the member is unable to submit a refill request in app.
What is Notify Member for Refill?
This macro is used when the scale display is not turning on.
What is /Scale Display Not Working?
Paychex members must have this approved before they are eligible.
What is a prior authorization?
This is the only third-party with which we can share member information without a HIPAA form on file.
What is FedEx Choosewell?
This group will handle requests to reschedule a coaching appointment if the member is unable to do so themselves.
What is Coaches?
This macro is used when a refill request has already been submitted.
What is /Refill Already Requested?
This is the macro we send when a member requests medical records or other PHI.
What is /Medical Records Request?
This team is responsible for eligibility error callback requests.
What is Tier 2?
Labs, clinical intakes, coaching notes, program dates, payments, and Calibrate Central details are all this.
What is medical records or PHI?
This is where tickets are sent when the caller gets an ineligibility message when trying to sign up.
What is Tier 2?
This type of refill request is out of scope for Tier 1, and GBAs should never proactively offer this service.
What are courtesy refills?
If a DTC member requests reinstatement within 30 days, this is the macro we use to send to Tier 2.
What is /MX Tier 2 Handoff?
This is the first troubleshooting step in the Enterprise Client Eligibility & Enrollment Troubleshooting SOP.
What is confirm the caller is using the correct spelling of their first and last name?