UTR-UTE-DNC
The call cadence to UTR a member
What is 3 attempts over 2 weeks?
The campaign requires you to state all italicized verbiage word for word.
What is the OAH - Care Navigator Ad Hoc (CAHPS) campaign?
Outreach days to a member post-hospitalization.
What are days 10 & 18?
Warm transfer to this 3rd party for all markets (except for WI, DC, LTSS, and DC Non LTSS).
What is BeneLynk?
A successful contact, but declines or refused face-to-face visits
What is a UTE?
Campaigns such as: OAH - Care Navigator Outreach (new member), OAH - Care Navigator Urgent (HRA), OAH - Care Navigator Ad Hoc (CAHPS) are in this dialing mode.
PW tab to check if a PHV has already been set-up for a member.
What is the Member Visits Schedule tab?
Source of truth to identify if a member is eligible for a Medicaid Redetermination warm transfer.
What is IC Interaction Scripter tab?
The PW banner will display an icon (circle with a line through) with in this type of member's profile.
What is a DNC member?
Main components of this campaign requires: completions of HRA & SDoH assessments, schedule HCs, address open STAR Gaps and COA-STAR Gaps.
What is the OAH - Care Navigator Urgent Campaign (HRA)?
Complete this assessment if necessary during Day 10 outreach.
What is the HRA/RSA?
Department you would warm transfer WI market members & DC Non LTSS members.
What is the dedicated market Member Services?
When a member displays displayed inappropriate or threatening behavior telephonically.
What is a DNC-Staff Identified member?
When you complete an initial/welcome call you must task this person, only if the member resides outside your market and there is no Assigned Care Navigator on the Care Team.
Who is Deathra Howard?
Assist to directly schedule this appointment if necessary.
What is a House Calls visit?
This visit is normally a priority in all Care Navigation calls. However, this visit (or warm transfer, if needed) would not take priority over Medicaid Redetermination.
What is HouseCalls?
You normally wouldn't outreach to this member once this status is in place however, there are exceptions such as: CAHPS members, HRA tasks, Readmission (TOC/PHV) tasks, FMC (ER f/u) tasks, Any external referrals or tasks
What is a UTR member?
The STAR Gaps that must be addressed during a CAHPS call.
What are the OMW, FLU, & FMC STAR Gaps?
PHV/PHC outreach/call cadence on Days 10 & 18.
What is 1 attempt (on Day 10 & on Day 18)?
Use this selection in the Medicaid Redetermination Transfer Result field drop-down in Interaction Scripter when member doesn't want a transfer and you provide the market appropriate phone number.
What is Medicaid Redetermination Declined?