Where am I going?
To reach a clinical review nurse and should only be used when a caller wants to provide additional clinical information or has questions regarding clinical information on a Denied/Partially Denied case.
What is PSU Ext 20636 for ISA or 2763 fo IO ?
Insurance Broker calling for status of the case.
What is consent from the member in each case to speak with them?
See the Horizon HP guide for special consent info specific to Horizon members
Improve the Health of the lives we touch, Be the leader of value. be the employee of choice, deliver on our financial promises.
What are our goals for drive to 2025
A usually benign tumor made up of blood vessels that typically occur as a purplish or reddish slightly elevated area of skin.
What is a hemangioma ?
Applies to everyone , no matter their role
What is Our code of Ethics and Principles of conduct ?
To reach a Non-Clinical agent for basic Post Decision Options and Peer to Peer scheduling.
What is the PSU non clinical extension ?
ISA 20636 and IO 49600
Education under when to connect to PSU
A specialist is calling requesting status check on a case by the primary MD.
What is can I give status to specialist?
If the specialist can verify the HIPPA correctly, yes provide info but DO NOT make changes to the case
Foundational growth, accelerated growth , cross- enterprise leverage
What are the key pillars of our growth Framework?
A mass in the uterus consisting of enlarged edema growing in clusters resembling grapes and usually associated with departure of the fetus.
What is hydatidiform Mole ?
Knowing of or suspecting a violation
What is reporting a violation of our code?
Found under our company code of ethics
IS there anything else I can assist you with / please hol
What is the after call survey?
Member calls for status .
What are ways to search for members case?
Under search 1 episode 2 case number 3. Patient ID 4 Patient name starting with last name
lastname#firstname* Doe*john
What is the direction for how we achieve healthy sustainable growth?
A measure used to diagnose the extent of carotid atherosclerotic vascular disease.
What is IMT? Intima-Media -Thickness ?
Your colleague shares details about a violation.
What is how do you fulfill your duty?
Speak up and report any concerns in good faith , even without knowing all the facts
Members want post decision options.
What is the new PSU Member que?
Hours of operation for this new queue are Monday-Friday 7am-9pm EST. The Internal extension is 20154. A cold connection should be made to this extension (A warm connection should only be if the call is escalated).
Member wants to change the status to Urgent.
What is Medicare memebr? Members that are not medicare can not switch a case to urgent , advise them to call their MD to request case as urgent
The future of healthcare is built on the vitality of every individual and every community.
What is the 2025 VIsion ?
Production by an individual of antibodies against elements of the tissues of another individual of the same species.
What is isoimmunization ?
Primary Privacy Law
What is Hippa ?
Extension numbers and departments.
What is the Master Extension List ?
This will include extensions used by Non-Clinical agents, Clinical agents, Consumer Engagement, etc.
The member is Resticted\Evi Employee
What is the supervisor line ?
Agents will revieve a pop up if the case is for an employee within the legacy companies. Caller should be warm connected to a supervisor listed on the resources page. DO NO connect to a SME agent
Our mission is to improve the health and vitality of those we serve. We will strive for a better future built on the vitality of every individual and every community.
What is Drive to 2025 ?
An inherited disease due to faulty metabolism of an essential amino acid. Left untreated, the disorder can cause brain damage and progressive mental retardation.
What is phenylketonuri ?
To improve the and vitality of those we serve.
What is our mission ?