Triage
Name one reason to initiate triage.
When providing decision support name the three opportunity documentations that are required?
Current Symptom Assessment, Psychosocial Assessment, and Provider Assessment
You are providing pre-op education for member, what keyword would you utilize in the search for documentation purposes?
Surgery Prep
Name three Complex Medical Conditions (CMC).
-BRS – Bariatric Resource Services
-CRS/CSP – Cancer Resource Svcs/Cancer Supp Prog
-Fertility Solutions
-KRS – Kidney Resource Services
-NRS – Neonatal Resource Services
-Transplants
True or False: For Call One, you must only document conditions and medications for medical history.
False - you only have to document Conditions unless member mentions any other medical history options
Name one disposition definition that would require a member to call 911.
Name 3 Decision Support Conditions.
What is the purpose of health education?
Clinical education when not included in decision support topics.
Name one External Program.
-Real Appeal
-Best Doctors
-Second MD
-Calm App
-PHS
Member has upcoming surgery. There are no available appointments in MHD. What do you do next?
Assign to work queue listed in SAI with NOMHDAPPT Keyword and completed Call One Assessment
You triaged an out of town member and determined member should be seen within 8 hours for symptoms of sore throat and fever. What are the options to provide to the member?
Virtual Visit, Urgent Care, and/or Retail Clinic
You have just triaged a member who called seeking local ERs and have provided disposition to an urgent care, what might you chart in TDS?
Right Care
You provide health education on a call, where will this be counted in your call metrics?
Engagement Services Delivered
Member requires BRS for bariatric surgery benefit. What queue will you assign the program referral to?
OBESE
Member is calling in regard to an inhaler prescription price cost. The medication is albuterol 90mcg Inhaler. What Call 1 Disease Management program are you anticipating utilizing based on this information?
-Asthma
-COPD
You get a misdirected behavioral health triage call and member sounds distressed. What are your next steps?
Contact UBH Crisis Line - 800-496-5819
True or False: For TDS, you must only document conditions and medications for medical history.
False. You must document conditions, medications, and allergies. Documentation of provider should be included if mentioned on call.
If a health education topic is not available in the health education tool, what would be your next resource to use?
Health and Wellness Website Database (Approved Websites on Health Education tool)
Member is interested in fertility solutions program. What queue will you assign the program referral to?
OVARY
True/False: Member calls regarding denied PA for osteogenic stimulator to lumbar spine, following spinal fusion. RN should be anticipate offering/enrolling member in COPD program?
False: RN should consider GCM based on info provided.
You triaged a member with cardiac symptoms and have determined a 911 outcome. Member is refusing 911 transportation. What are your next steps?
Ensure member has someone with them to take them to the ER immediately.
What should be completed on a call in order to document an accept for a preventive care topic?
A knowledge gap has to be closed in order to accept a preventive care topic.
True/False: If member declines health education based on trigger word, no documentation is needed.
True.
Member has cancer and is interested in programs available. Their plan has both CRS and CSP available. Which one do you assign the member to?
CSP
Name all 5 Call One - Disease management programs:
1. CAD
2. Diabetes
3. Asthma
4. Heart Failure
5. COPD