A
What does the acronym AHH stand for?
American Health Holding
How Many diseases are managed by DM dept
9
what are the patient verifiers?
Name, DOB, Address or Employer/Group Name or Member ID
Do we use the back button on the browser to go back?
No we use the one in iSuite
Is a person diagnosed with weakness eligible for DM and what is the reason for your answer?
No because weakness in not one of the 9 diseases that we manage
When was AHH founded?
1993
Why does AHH analyze a client's medical and pharmacy data claims?
To identify those members that qualify for the DM program
When searching in iSuite and can't find the person may name is hyphenated what do we do to search and find them
We use the wildcard which is the percentage sign "%"
can we update a members phone number?
yes once we confirm that it is correct with member
can we enroll a member to DM via speaking with their husband/wife?
No we must speak with the member only
DM staff is made up of?
Care Management Associates (CMA's) and Nurse Health Coaches (NHC's)
How often is the PAM assessment done
every 6 mths
When we have an invalid phone number or email what do we do when notating the case
place the wrong info in the notes
When creating a case do we ask for "other insurance" or do we leave blank?
We leave blank
What should the Acuity level be set to?
High
Tre or False?
An impression of the business is formed in the first 6 seconds of your call?
True
If attempt to NHC is unsuccessful or mm request a call back what do we do?
Schedule call back 2 weeks out
What are the steps/ call flow if you speak to a member
Introduce the program
verify receipt of Welcome Letter/ Invitation Letter
advise OF INCENTIVES/DISINCENTIVES IF APPLICABLE
verify primary disease
Ask if they are interested in participating
should inactive members be enrolled to DM?
No as they do not have insurance coverage and only active members can be enrolled
When notating a case what are the option that can be placed in Note type
Attempt Member and Contact Member
What does the acronym URAC mean?
Utilization Review Accreditation Commission
How are potential members engaged/ contacted
They receive a letter with insurance welcome package.
How are cases created?
Predictive Modelling
self-referrals
AHH Health Assessment Referrals from other programs
What are the 3 options to choose from at "Call Note Action"?
Successful
No Answer
Close Case
If we get a member that does not have a DM case in iSuite what do we so and where do we go to initiate it?
We would build case by going to new request