Hip HIPAA Hooray
This is what we can provide when we are not able to verify HIPAA.
This is what we call durable medical equipment
What is DME
This will be the 2025 vendor for Food & Home card/ OTC
What is CVS
Member service guides can make clinical or health suggestions for our members.
What is FALSE?
We should ALWAYS refer the member to their Primary Care Provider for a referral or guidance on any specific health question.
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
PHI forms authorize Devoted to release information to a specific person, but if they want to take action on behalf of a member we will need this form on file.
What is POA (power of attorney)?
We are always advised to trust this if we are not sure about coverage or benefits
What is the EOC (evidence of coverage)
In 2025 if you don't have OTC you may still have a Food & Home Card
What is False:
We won’t offer a separate OTC benefit in 2025
Daley, your supervisor, has three kids.
What is FALSE!
Daley, has one daughter.
When you come across a T3 badge on a call note and first call resolution is not possible, per helpdesk, this is who you assign the case to
What is the Complex Case Resolution Team?
These are the 3 other most common points of verification that we use on inbound calls if member does not provide home address or phone number
What is member's full legal or preferred name (if listed in Orinoco) Devoted ID and DOB
New to 2024, guides are prompted to catch the member while we have them inbound by a red flag known as this.
What is NBA?
What is MPPP?
What is Medicare Prescription Payment Plan:
Program that allows members to spread out their OOP prescription drug costs over the year instead of paying large pharmacy bills on the spot.
If a member has 3 NBA flags on their profile guides should complete all of them.
What is FALSE? Guides should always complete the first NBA to present in the profile. Orinoco will determine which NBA is priority and will present that one first.
You will choose this option if a member calls back from a follow up case, you provide the information highlighted, and there is no more follow up required?
What is Action Reason: Resolved?
This is what must be verified when an Authorized Representative calls on behalf of a member.
What is
Obtain the correct quantity of HIPAA identifiers, three if inbound and two if outbound.
Obtain the full first and last name or the authorized representative as listed under the Care Team tab.
Obtain the relationship to the member as listed under the Care Team tab.
?
These plans can be a little tricky if they're coordination only, but our tier 2 or helpdesk team will assist if needed
What is D-SNP
True or False: MPPP will reduce the overall OOP cost of the drug for members.
False:
It does not reduce OOP costs- it changes how & when members pay.
We are currently operating in 12 states
What is FALSE?
We are currently in 13 states but will be in 20 by 2025!
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 outbound calls, if a member is skeptical about releasing information the member can do this.
What is hang up and call us back at 1-800-DEVOTED (338-6833)?
This is what HIPAA stands for.
What is Health Insurance Portability and Accountability Act?
How long is the grace period before a MBR is involuntarily terminated from MPPP for lack of payment?
What is 2 month grace period.
NBA Opportunity Success Rate is the number of successfully completed NBA's divided by the number of opportunities with action taken.
What is FALSE! The number of successfully completed NBA's divided by the number of presented opportunities
At the end of your shift if you have an open case, you should do this?