Commonly used Systems
Named after this folded membrane, this system houses member information and allows us to engage members.
What is Golgi?
This is the main objective of your call.
What is to schedule an appointment/ enroll a member?
The correct disposition for an enrollment.
What is " successful-enrolled (tablet or SMS)?
We provide access to this, if a member is in need of a prescription refill.
What is " a pharmacist "?
A proper opening for an outbound call.
What is --
" This is (ES name) with Carebridge Medical Group, partnered with ( insurance plan)" ?
In lieu of clocking in, it's important that I change this status to start my shift.
What is Golgi?
The correct action when the speaker confirms the member cannot be reached at the number dialed.
What is delete/remove the number?
The member hung up immediately following my introduction.
What is a pick up/hang up?
Although we are not the direct vendor of these products, we can provide members access to them.
What is DME or OTC/Hygiene products?
These are the four places we should put confirmed appointment information.
What is " ES schedule chat, appointment notes, attempt notes and disposition notes"?
This program is where you can locate the most up to date job aids and workflows.
What is GitBook?
After 5 consecutive outcomes of "number disconnected" in enrollment queues , Golgi will remove the member account from the current queue to this one.
What is the research queue?
The member's daughter answers, saying her dad has been in the hospital for the past two days and would likely remain for the rest of the week.
What is " Callback- Temporarily not in home" ?
Our community navigators assist with these two main areas of vulnerability for our members.
What is food and housing insecurity?
Blatant call avoidance ( not speaking or muting your call, so the member disconnects the call), hanging up on a caller, cussing or yelling at a caller, etc.
What is " red flag call"?
While not required to use , this is a great resource to help provide easily accessible information in your own words.
What are/is Sticky Notes?
All of these have to be marked to complete the enrollment checklist. (name at least 5)
What are? (any 5 of these)
Reviewed Date of Birth
Reviewed Address
Reviewed Preferred Language
Set Interpreter Needed
Set Communication Preference
Set PHI Authorized Contacts
Set Preferred Phone Number
Set Emergency Contact (Verified/Opt Out)
Confirm Tablet Status (Required or Opted Out)
Scheduled CCAThe member's daughter says she is too overwhelmed with the care team that her father already has. She does not need additional help now.
What is "unsuccessful-soft decline"?
The tablet may be a better option for those in rural areas or those that do not have a stable internet connection for this reason.
What is, the tablet has it's own data? (some version of that)
It is advised to provide this statement at the end of the call for wrap up!
What is
"Remember, the most important part of benefiting from our 24/7 program is completing your appointment with [provider name] next [day of visit].
[She/He] looks forward to meeting you!"
While out of the ordinary for you to utilize, this system is where our providers refer to patient charts.
What is Elation?
Provide the steps for sending a tablet to an address other than the member's permanent residence.
What is submit an alternate address task via tasks on the member detail page-> device maintenance(subtask) -> type out address in the notes in the instructions section?
The member is moving from TN to FL next week.
What is "unattributed- loss of eligibility"?
You are on the phone and a member becomes ill, suggest this for prompt assistance but, do this if you are unable to get someone.
What is contact the " acute queue" and "create a triage callback task"?
These things constitute an auto-fail.
What is "failure to verify HIPPA prior to sharing member PHI, failure to leave voicemail, failure to document outcome of the call (disposition and attempt notes), and failure to show up to Audit Session"