Member Scenarios
Member mentions that they are taking care of a sick family member. What all can you do for the member?
Offer EAP for self and all household members
Offer Caregiver Coaching (if has our managed benefit)
Do you send a survey to all members?
At this time, we only send a survey if we have had a connection with a member
In your opinion, member should have been sent to crisis when speaking with a PA. What should you do?
Welfare task. You do not need to ask our SOS if you should do a welfare task. Go with your gut
True or False: If a member is needing Neuropsychological Testing, we can send them a list of providers, offer an appointment search and review benefits.
False. e can only provide a list of referrals. No appointment searches are offered for Neuropsych testing services and it is a Medical benefit - Medical would need to review with the member.
Before asking SOS for help, what is everything you should do first?
Check all of your resources (i.e. KX SOP's, FAQ sheet, SP resources, personal notes, search webex chat for similar questions)
What do you do if you want to refer a member to CSP?
While on the call with member, transfer to LTC queue
What resources do we have to find a provider for a member?
SAS
Appt Search (through the team or self)
External Appt Search
How many days does a CC have to contact a member after first call into a PA?
Concordia - by the 4th business day
All other accounts - between 3-5 business days
True or False: All emails sent to a member must be sent secure
False: Member can be sent a provider list only via unsecure email.
If you leave a voicemail for member or provider, what is the only things you can leave on the message?
NO PHI! Only your name, branding, your phone number and working hours. No other details can be left on a voicemail.
What do you do if member refuses to HIPAA validate on a call?
If member has an email address on file (either in demographics or in the PA assessment) you can send the member the initial email. If member does not respond, send UTC 5 business days later
What do you give to an adult calling in for another adult?
Release of information - for further follow up calls
Personal Representative Form - If adult wants to generate an auth for another adult
What Confide account does not allow for "can use EAP up to 30 days" from term date?
BAE - When an employee terminates their employment with BAE Systems, the effective date of the EAP program is the end of the month of the employees termination if the termination is involuntary (i.e. due to lay off). The program termination is effective the day of termination if the termination is voluntary (employee resigns). Authorizations obtained prior to the termination date are valid until the authorization expires.
True or False: Call Recording Disclaimer comes before HIPAA validating
True
Before you speak to a provider about a member, what do you need to do?
Get permission to release permission to release PHI to the provider and make sure that the permission is documented in your CC assessment
You are about to call out to a mom that had called in for her 20-year-old son needing resources for therapy. The advocate had received verbal permission from the adult son on their initial call to speak with mom. How long does that verbal permission stand?
7 days
What are the only reasons we would not follow up with a member?
Claims only call, met crisis criteria, LTC/Crisis assessment completed after PA assessment, misdirect call (intake not done), EAP CC outreached customer (transferred to LT or declined PA transfer or did not answer), active BH CM already involved, no customer contact information available, calling within 30 days of last CC/LTC contact to get existing EAP auth on file or only quoting ongoing benefits, customer declined CC flup
Starting 12/6/24, what will be the new requirements for calling members ?
Clinical - 3 attempts
Non-Clinical - 2 attempts
True or False: We do complete an external Appointment search if a member does not have Cigna as their insurance carrier
True. use Confide - CC - External Apt Search SOP
What script needs to be given to every member when they give you an email address?
Secure Script or Non-Secure Script
What do you do if both an adult calling in for another member AND the member both call in?
What is required to discuss with a member on all first follow up connections (if time allows)
What do you do if member is rushing you off the phone and you can't go over everything on the call?
Inform member that you are going to send member an email from <correct email bin> with further information about services available to member. This is where you can include all the information that you were not able to go over on the call. Make sure it is documented all the information that you sent to member to get credit
True or False: We offer to follow up with a member after first connection
False: We always inform that we will follow up. Never offer.
How do you know if a Ball Corp member was acquired by BAE?
There should be a BAE registration in TC so search for name DOB first.
Search CAMS for active managed registration and OneView to confirm the account.