Hip HIPAA Hooray
This is often referred to as ePHI
What is electronic protected health information
This is what we call durable medical equipment
What is DME
This KB will come in handy if the member has questions about how to use Devoted's Member Portal
What is Member Portal (my.devoted.com)
We pride ourselves in taking care of members like friends
FALSE we take care of members like family
If a member asks you to send them information via SMS you will want to create a case to this team
What is Digital Guides
These are the 2 other points of verification that we use on inbound calls if member does not provide home address or phone number
What is member ID number and DOB
This category on the Balanced Scorecard refers to the potential inbound member connections (calls) per day compared to peer groups
What is MCR aka Member Connection Rate
This KB outlines all the ways members can use their OTC benefit
What is OTC Health Solutions: How can members use their over-the-counter (OTC) benefit?
The Yaks of Love are named after a big cow that Alex knew as a kid in rural Vermont.
FALSE it was a goofy nickname that I tolerated from a single friend in high school
Create a case to this team if the member's needs are outside your tiering and you're unable to uptier or if you have tried to first call resolve an issue but you're unable to FCR today
What is the SCOUT team
This is what HIPAA stands for
What is Health Insurance Portability and Accountability Act
We are always advised to trust this if we are not sure about coverage or benefits
What is the EOC (evidence of coverage)
Want a better understanding of how Medicare works? Be sure to check out this KB card
What is Medicare Basics: The ABC(D)s of Medicare Coverage
Use the SLACK Channel Guide 2024 if you want to know what each slack channel is used for and when you should post in them
You will choose this option once work on the case is done
What is Resolved
PHI forms are used to release information, but if someone wants to take action on behalf of a member we will need either of these forms on file
What is AOR (appointment of representative) or POA (power of attorney)
When working on your call metrics this is a combination of ACW, ring time, and talk time.
What is AHT (average handle time)
This KB is a great starting point if you want to learn more about claims (hint: there are 2 but will accept either as an answer)
What is A Guide's Guide to Claims or Claims FAQ
Our plans are often referred to as Part C plans
TRUE (part A + part B + part D = C plan)
These cases are most commonly created when a member doesn't feel well, but can also be helpful if a member needs a referral, has a medication need, or if they need durable medical equipment
What is Request Clinical Guide Transfer
For transfer calls received from someone outside of Devoted we need to verify these (example: a vendor transferring a member)
What is first & last name and 2 of these: full address, DOB, member ID, phone number (same as inbound calls that are not transfers)
This channel was recently renamed to Health Emergency Support channel and it is used when a member is experiencing either medical or mental health emergencies
What is SOS
Use this KB card when a member requests to have their premium automatically deducted from their SSA check
What is Member Premium Billing FAQs
Our Brand and Service Principles consist of 6 guiding virtues that are at the heart of all we do here. Extra 100 points for each one you name
TRUE
Listen hard and care fiercely; Relationships are everything; Earn trust as problem solvers; We're "all-in" partners; Celebrate member wins; We're hyper-compliant
When you come across a T3 badge on a call note and you're unable to resolve the issue, this is who you assign the case to
What is the Complex Case Resolution Team