Category 1
What does uploaded mean in sharepoint?
The member has been seen this year.
Where does it show you when the last letter was sent out?
The wave in Five9
What is the recycled time for outreach letter not sent?
1-2 weeks.
What are the four things you have to verify for TF/TC?
Full Name
Date of Birth
Zip Code
Member ID
What is included in the test for Carefirst?
Blood and Urine sample.
Once in the Patient Profile, what do you click on to get to Verbal Authorization date and Consent date?
Market HP Program Risk.
Who is Pop Health Care owned by?
Guidewell.
What does the X stand for in Elderplan?
The Bronx.
What is the program called in RI CS?
House Call by Blue.
You're calling a TF member who refuses to validate any information with you. But, they insist you tell them why you're calling. What do you say/do?
Tell them it is the insurance's policy that we validate this information to ensure we're speaking with the correct member and that will re-send our informational letter. Encourage them to call member services to validate us and we will try back later.
Which campaign is the Multnomah territory?
MODA.
Who is the nurse that gives gifts and treats to the office and what plan does she work for?
Nancy O'Rourke, EX
Why are members referred to CS?
Chronic condition, Insurance company thought they'd benefit, Recent hospital stay.
When you receive an ib call from a member who wants to reschedule their exam what do you disposition the call after getting them rescheduled?
If last disposition anything other than exam scheduled? disposition member inquiry and ghost call to mark exam scheduled
What 3 health plans share the same zones in one state?
BF,FH,TF
Name all the people on the other side of the office.
Kathy, Matt, Jim, Donna, Stacey, Laura, Missy, Mary, Jumana, Ilyah, Monica.
Can members be seen in hotels/motels?
No.
What programs does not allow spouse referrals?
EA, EM, All of Caresight
What is the number of programs that you have to get approval for a spouse referrals?
6
What disposition should be used if you reach a business directory asking you to chose an option person to move forward?
Wrong Party.
Which campaigns offer gift cards and how much are they for?
BF ($30) TC ($50) (Trick answer: Denver health ($25)
What are the goals on the agent occupancy report?
Calls PH 20,
Not Ready % Less than 15%,
On Call % Greater than 40%,
ACW% Less than 15%,
Scheduled per hour Greater than 1.5
Where is the head quarters of Pop Health Care located?
Tempe, AZ.
What do the colors yellow, red, pink, blue, and orange mean in EMR calendar?
Y- in home
R- communication apt
P- out of office
B- working from home
O- working at facility
In which programs do you need to say the call is recorded for quality purposes?
BF, BC, TF, TC
(Florida Blue and Tessellate)