EAP
How many EAP authorizations can we (advocates) write in 1 year?
up to 2
If an application says "Bot In Process", what does it mean?
This means the same thing as the Packet Received stage. Cigna has received the signed contract back from the provider. Use the Packet Sent and Received Date section to find when we received the packet. If there are no recent notes in the “Activity” section, advise the caller to allow more time.
If a member meets their OOP for the year, do they have any member responsibility?
BONUS: When does the OOP reset
No
BONUS: When the year ends (either end of contract year or calendar year depending on the plan)
Which call guide and which section can you find information for a individual provider looking to terminate their contract?
PR Call Guide- 7.1-a
How many hearts does an octopus have?
BONUS: What Disney movie gives us this answer?
BONUS: Finding Dory
If a caller declines the EAP authorization letter what pieces of information do you need to give them?
An INN clinic wants to change their service location. What steps would you take?
Send the caller the Clinic Location Changes for Existing Clinic Contracts form in an email attachment or fax (do not send them this link as they will not be able to access it)
Which benefit bucket do you look at when quoting TMS benefits?
OSP (aka IOP)
PPO, Cigna West, TPAs
What is the Barbie doll's full name?
Barbara Millicent Roberts
What steps do you take if a caller wants a third auth within a calendar year that has a different presenting problem from the first two?
Follow the steps in section 2 of the EAP Call Guide
What would you do if a contracted clinician was looking to get an individual contract?
Section 5.1-c of the PR call guide
If a caller asks a lot of additional benefit questions after your quote, do you document this?
YES!
If a provider wants more information about what a third party policy is (TPA). What can you do?
Send them the Ecard!!
How long can the wood frog hold its pee?
up to 8 months!
A caller is from an employer stating they had a mass layoff and want to bring a provider on-site to their work. What steps do you take?
All initial requests: Warm transfer the caller to the EAP CIRT Manager listing in Finesse or dial 855.275.2591
A HealthPartners provider wants a rate increase. What would you do?
Advise the caller to contact HealthPartners directly
If a caller says they want benefits for all levels of care, which levels are included?
You can always ask the caller to clarify!
Normally, it is IP, RES, DTX, IOP, PHP, OP (sometimes people don't want routine outpatient)
Do we require discharge clinicals for IOP? What if they want more sessions authorized?
No!
They fill out the same form they did initially on cignaforhcp.com
Where was Hawaiian pizza created?
Ontario, Canada