EPIC/CHEERS
A member calls in with urgent non-emergent symptoms. They should be encouraged to visit:
Option A) Their PCP.
Option B) UCVV or Urgent Care.
Option B) UCVV or Urgent Care.
Chats can be transferred to...
Name the 2 destinations.
1. Unassigned Care Advocacy
2. Another Care Concierge.
A member needs their EOB for an appeal...
THEY SHOULD CONTACT WHO?
Aetna
Can members switch from Traditional to Select?
NO.
Life event revisions are (ALLOWED or NOT ALLOWED) and must be (IGNORED or SUBMITTED) (AT ALL TIMES or WITHIN 30 DAYS).
Life event revisions are allowed and must be submitted within 30 days.
A member calls in with chest pain (persistent for 2 days). What is the order of operations in Epic?
1. Loop CC manager in.
2. Send the member to the E.D.
3. Create a CRM to document the symptoms/interaction.
4. Create an encounter and route it to the employed provider's clinical pool (if applicable).
Chat Reason or Chat Outcome?
This provides the resolution of the conversation.
Chat OUTCOME.
We should proactively reach out every ___- to ____ days.
2; 3
VPCP patient eligibility is determined by...
The VPCPs.
Care Management is a plan requirement for _______.
-Select members.
-Certain chronic illnesses.
-Some people, but they are notified.
Marking a CRM as reviewed (DOES or DOES NOT) indicate it has been resolved.
Marking a CRM as reviewed does not indicate it has been resolved.
In Five9, your email/extension is found in the..
Name the page/subsection.
Agent information on the home tab.
Or, at the top of the home page.
-Mental Health O.V.-
-UCVV-
-PCP-
-Urgent Care-
-Mental Health O.V.- $10
-UCVV-$0
-PCP- $10
-Urgent Care- $40
Life events include...
Life events: baby being born, dependent leaving plan, divorce, marriage, etc.
C.C.'s can update medication and explain imaging results to members because the access has been granted in Epic, to assist them.
True or False?
-FALSE.
-NO.
C.C.'s can update which immunization records?
Only the FLU.
This is MANDATORY when making an outbound call.
What is the website for verifying/finding AdventHealth providers in the select plan?
C.C. / U.C.A. / A.C.A.
-Which entity covers clinical assistance?
A.C.A.
What is the time frame of a C.C. manager reviewing/commenting on a CRM/Encounter escalation?
At least once a day.