PepsiCo
The PepsiCo term for an advocate
What is a Health ACE. Health ACEs are highly trained service and clinical team members dedicated to Assist, Connect, and Educate (ACE) PepsiCo members. As a Behavioral Service Health ACE, you are responsible for ensuring that members experience white glove service.
If a member is calling in for the same clinical issue but in a different year should you open a new case or assign to existing case?
Open a new case
Main points you should hit at the end of a call
What is: 1. Final offer of assistance 2. 24/7 availability 3. Customer Survey
Term used to refer to LTC
After call work goal for member calls
What is 260 seconds
Where you find who the dedicated medical Health ACE is
What is active alerts in OneView
PepsiCo members have both INN and OON benefits. True or False
False - only have INN benefits
Necessary pieces of information for a secure email
What is: "You will be asked to create a password to retrieve the information so that only you have access to what I am sending. Please be aware that emails can sometimes filter to a junk or spam folder, so, if you do not receive it within the next few hours, you may want to check those folders or contact us to receive the information a different way.”
The three enhanced services included with the CTBH and BH NAV products
What is: 1. 100% follow up on every interaction (excluding claims calls) by a Care Coordinator (CC) 2. 40-50 minute Licensed Telephonic Consultations (LTC) 3. Anyone eligible for CTBH/ BH Nav may also be eligible for 3 No Cost sessions through LES-
After call work goal for provider calls
What is 160 seconds
Term caller should be referred to both on the phone and within documentation.
What is a member.
Is Prior Auth required for IOP
YES --> Authorization is required for IOP. Once you’ve made an appointment, you provider will request an authorization.”
Necessary pieces of information for a non-secure email
What is: Before we send you an unencrypted email, we want to alert you that information contained in an unencrypted email can be at risk of being accessed by third parties during transmission or storage. Would you still like us to send this information non-securely
•The following are important details within the script that should be shared with your caller:
-Information shared in email can be at risk of being accessed by third parties during transmission/storage
-Getting consent from caller to send information this way
Yes, all documentation needs to be assigned to a case.
Case Type: Behavioral/EAP/Navigation
Case Name: BH EAP NAV
EAP Presenting problem: (always complete regardless if the call is for EAP)
Survey transfer goal for Member and Provider calls
What is 70%
The PepsiCo EAP Vendor
What is Spring Health
Where to transfer if a PepsiCo member has questions regarding wellness rewards and incentives or navigating and downloading the Evernorth App
What is Evernorth Care Guide
Trucare: Full assessment and case
CAMS: FEWB Authorization only + case Note "see TC CS ____ for additional information"
OV: yes
If 100% follow up is not shown under product features for California and USVI members in TC they must show ALL of these three things to be eligible for navigation services
What is: 1. They must reside in CA or USVI 2. Their product features list "Behavioral Fee for Service High" 3. "Eligibility and Benefits" sections shows CA or CA/VI listed in the active product
Number of success stories that need to be submitted per month.
What is 4
Inbound greeting for the PepsiCo account if the caller is HIPAA verified and if they are not HIPAA verified
HIPAA Verified: "Thank you for calling PepsiCo Behavioral Health ACE with Cigna, this is <Name of Representative>. With whom do I have the pleasure of speaking with today? How may I assist you?"
HIPAA not Verified: “Thank you for calling PepsiCo Health ACE with Cigna. This is <name>. With whom do I have the pleasure of speaking with today? How may I assist you?”
The only system referrals should be sent from for PepsiCo members
What is via the myCigna mirroring tool. PIT should only be used if the mycigna mirroring tool is not available
Who is not eligible for Staff Assisted Scheduling? (Name 5 of the 11)
- Anyone under age 10 for both EAP and managed benefits
- Anyone with a Management Referral
- Adult calling for another adult
- Intensive Outpatient Program (IOP)
- Applied Behavioral Analysis (ABA)
- Transcranial Magnetic Stimulation (TMS)
- Neuropsychological Testing
- Psychological Testing
- Primary Medicare
- CHAM
- Minnesota customer seeking therapy using insurance benefits
Two things you should check in CAMS to determine if a member has navigation services in CAMS
What is: 1. If the customer's participating network is HMO, they have BH Nav/CTBH. 2. If the customer does not have HMO listed, verify if PPO is listed in the Par Net line. If PPO is listed and Capitated is listed in the customer line, the member had BH Navigation/CTBH. (Call guide section 8.2-b)
Reporting errors goal per month:
-Fallout errors
-Missing case and Timeline reports
-TC BH Assessment errors (100% FLUP and email address)
What is <8 per month