Call Flow
This is the act of repeating key details back to the member to confirm understanding.
Recapping
This metric tracks adherence to scheduled work times
SCAD
This should be done before discussing account-specific details with a member.
Verify the member
This resource should be used when you are unsure of a process or policy
E.Policies
Remains Not Covered
Weight Loss Medications
This shows understanding and concern for the member’s situation.
Empathy
The Metric for Scad
94%
A resource that should be pulled on every call for plan specifics
PSPP
Sort doctors and facilities into tiers based on their performance and ability to save money.
Multi tier plan
This step explains available options to the member before closing the call
Offering ISM suite of services
Evaluates the quality of interactions based on predefined criteria, such as colleague professionalism, accuracy, and adherence to scripts or guidelines
ACE
Must be within 25 miles of the members home, a tier 1 (Maximum Savings), provider is accepting new patients, and correct provider role.
PCP Choice Criteria
This score is measuring the likelihood of the member recommending our services to others.
NPS
a benefit that provides each enrolled member up to 5 services from a pre-defined list of in network services covered at no-cost (100% paid) prior to the application of the deductible and/or coinsurance.
Flexible Five
Non-emergency charges incurred outside of the United States, Home births, Cancelled or missed appointment charges or charges to complete claim forms, Services for or related to the following types of treatment: aromatherapy; sensory or auditory integration therapy; primal therapy; rolfing; psychodrama; megavitamin therapy; bioenergetics therapy; vision perception training (vision therapy); or carbon dioxide therapy
Plan Exclusions