P-HUM 7, 8, & 9
How do you answer incoming calls?
Thank you for calling Bright Health Utilization Management, my name is _____________________ I am a Clinical Associate Representative.
Please note that this call may be recorded for quality and training purposes. May I have your name, title, and a good callback number just in case we get disconnected?
UM Committee and P&T approves clinical criteria
Pharmacy and Therapeutic
What tab should I select to view TAT?
What is the Services tab, then turnaround time
For a phone call or a fax, what type of note would you enter?
What is a Contact note
For contact notes which one of these things must be include?
A) Caller's name and title
B) The provider's address
C) The time of the call
A) What is The caller's name and title
What 3 HIPAA identifiers must be verified when taking an inbound call?
What is Bright's Mission and Vision Statement?
At Bright HealthCare, we believe quality healthcare should be accessible, easy and affordable. Our approach to plans, services and benefits make health insurance easy-to-understand and easy-to-use.
What screen can I find the diagnosis code?
What is The general information tab
Where do you go to see view task?
What is Search, then Task
What is the name of the task bucket for LOI?
What is BUCSA Clinical/ Information Requests
When do you give out information?
Upon request
Who is the Chief Medical Director?
Christine Kilroy
What is the name of the form emailed to the medical director for peer to peer?
What is the Peer to peer intake form
Where would I find an AOR?
What is the All Documentation tab
Where would you find the approval dates for the authorization?
What is services, then the service line
How many days to respond to an administrative request?
1 business day
Can a member request an ID card on the Bright website?
Yes
If an authorization is urgent what level would you task it?
What is High
What does service level 1 mean?
What is network validation
Where would you locate the name of the facility in the authorization?
What is the service tab
Where do you find the PA list? (what is the path)
Where can we find the Provider List?
Bright Website
What tab would you check to see if the member has any reviews?
What is the Activity tab
What to places would you search to see if a provider is in network?
What is CareRadius and Brighthealthplan.com
How many days from the denial date on the letter can a provider call to schedule a peer to peer?
What is 5 days