Scripting
The closing of an outpatient no precert required call
What is: “HCM does not require precert for this outpatient service, however should the patient become inpatient we would need a call back to start the certification process. We highly recommend you contact the benefits department for benefit, eligibility and coverage information. Would you like that phone number?”
You have a caller speaking another language. What SOP do you use
What is Language Line
To differentiate groups with the same name you must use this
What is Group Number
Member is open to CM and you get a no PC required call. You must..
What is, send a task to open CM
Email includes a read reciept
What is, respond with approval to send
The disclaimer read when a member is showing termed in TC and in family files.
What is Eligibility Discrepancy Disclaimer
Where to find if precert should be started for workers comp
What is Other Insurance
Any time you must start a precert for this group – a case management referral must be made
What is PSERS
Member is not open to CM. Member has new Covid 19 DX. You must..
You must have your camera on with no filters
What is, when a teams call is done with management
The question that can stop a precert after asking if they are calling to start a precert, but before even getting to the prescreener.
What is "does the member have any other insurance"
Where instructions on adding a provider are located
What is Precert Required SOP
Verify Network Status For All Inpatient and Observation Admissions for this group
What is COMMONWEALTH HEALTH CORPORATION
Member is in Open CM. Member would like to speak to CM. You must
What is, send caller to CM
What should only be answered before work, during lunch, or after work
What is personal matters such as calls/texts
The question that must be asked during the prescreen for an IP auth with an admit date prior to today.
What is "Is the patient still in house"
Instructions for navigating through a third party call for information on a members authorization
What is PAR - Member Verification
Calls for precert for Members with plan number AC06 of American Cyber Systems should be directed here
What is the benefits office
Alert Pod indicated another CM vendor but you have a Covid 19 case you must
What is, do not send referral if alert pod indicated another CM Vendor
Schedule after a long weekend
What is 10 hour shift
The question that must be asked when member does not have, NO PPO, Clear Health, Indemnity, ELAP or AMPS, Notification Groups or Group: Commonwealth Health listed as PPO
What is "Is this facility in or out of network with <the patient’s PPO>? "
Instructions on adding member over 30 days of age with HCM benefit riders
What is Temporary Member SOP
Member of Serfilco, LTD needs a specialized brace. What question must be asked prior to starting precert?
What is, does the value exceed $2500
Notification of a deceased member is made. Member was open to CM. You must
What is, send task to CM and update alert pod
How time sheets are submitted
What is, at the end of every week after PTO is put in if applicable