HIPAA
Member’s ID Number
Member’s First and Last Name
Member’s Date of Birth
What are some acceptable forms of member information?
925
What is a DUR rejection?
Must be done before emailing workflow
What is add note to episode with template filled out?
Played piano since 6 years old
Who is Kristen?
For every call with an interaction there must be
What is an episode?
Notes tab on member screen
Where to see written authorization on file?
Valid RTS reasons?
What are dose change, invalid day supply, lost, stolen, vacation supply?
Category: Tools in Customer Care Sharepoint
Where are the Email Templates located?
Lived in Hawaii for 3 and a half years
What are some of Jennifer's little known facts?
This based on caller type and reason for call
What is the problem/action field
Member Consent needs to be on file on this caller's end
What is a PAP?
Compiled Additional Message
What should be checked on every rejection?
Courtesy email sent when U&C over $10k
What is the Max $$ Over $10,000 A/M Notification?
Enjoys traveling, bowling, and skating
What are Dionnica's hobbies and interests?
Provides a detail description of the call
What are the notes?
These callers sometimes have a plan password they need to provide
What are group or plan representatives?
Age restriction, DAW Penalty, Non-formulary, Prior Auth., Quantity limit, Tier Exception
What are types of coverage determinations?
Email for member shows active in Admin, inactive in Pharmscreens
What is Member in Admin Not in Pharmscreens?
"slow progress is better than no progress"
What is Cambreya's quote to live by?
Profanity
What should never be included in call documentation?
Cover My Meds are verified as this
What is a provider or physician call?
JA when member is taking leave of absence, being discharged, or admitted
What is the Level of Care Change JA?
Person CC'd to every email
What is a supervisor?
I have to watch Spongebob after scary movies!
What are Ciji Lyons's little known facts?
Identifies how the caller’s issue was resolved
What is the resolution field in notes?