Call Driver Basics
What key information must be collected during a Provider/Locate call?
Specialty, address, provider name if applicable, gender, language, group where he belongs if applicable
Which tools are used to search for providers?
Find Care & PAAG
What is a good empathy statement for a member frustrated with provider wait times?
"I completely understand how frustrating it can be to wait for care, especially when you are not feeling well. Let's see what options we can find together to get you the help you need as soon as possible."
How do you access to the Find Care tool?
CRM Lightning: Access DEBUT from the Quick Links section, then click Find Care at the top-right corner of DEBUT.
You locate a provider, but the member says they have had a bad experience. What do you do?
Show empathy and offer alternatives and offer a grievance.
Why is it important to document the call driver accurately in the system?
For compliance purposes.
What filters can be applied when locating providers in Find Care?
Distance, Accepting Patients, Specialty, Focus Area, Method of Care, Gender, Ratings
What tone should you use when explaining a delay in locating a provider?
Calm, reassuring, and professional.
Which Home Health Care Providers does Tango reviews?
A provider is listed but does not answer calls. How do you handle it?
"Thanks for letting me know. I will report that issues and help you find another provider who is responsive and available."
How do you confirm a call is truly a Provider/Locate and not a Benefit inquiry?
Member's main question is related to a provider's network status.
What steps do you follow when the system doesn't return any provider results?
Increase the distance filter. Use alternative tools such as PAAG.
How do you respond when a member is speaking very fast and you are having trouble understanding them?
"i want to make sure i understand everything you are saying so i can help you properly. would you mind slowing down just a bit or repeating that last part for me? i really appreciate your patiente"
Ask caller to slow down their pace
What are narrow networks?
Narrow networks are smaller groups of doctors and hospitals compared to the larger Humana network. Only certain providers in a specific area with special agreements are included.
You receive a provider locate call but the member gives incomplete information. How do you proceed?
"lets work together to clarify a few details- like your location, preferred specialty, and availability. i will guide you through the questions to help us find the best match"
(Ask probing questions and preferences)
What's a calming phrase to use when a member is upset about a provider network status?
How do you know if a provider is in the network with PAAG?
Under demographics, go to the Directories and look for the one that matches Find Care network for that member. Same information can be found under Service Addresses.
How do you build trust with a member during a Provider Locate call?
Be transparent, consistent and supportive.
Can you locate doctors with the condition?
A member wants a provider who speaks a specific language. How do you handle it?
I will use language filters and search for providers who speak that language.
How do you know if a provider is part of an IPA?
By reviewing applicable alerts in CRM. Reviewing the PCP tab and checking if provider is part of one.
How do you show active listening during a provider locate call?
Use verbal cues and paraphrasing. "So just to confirm, you are looking for a pediatrician in the downtown area who accepts your plan, correct?""
How do you report incorrect information?
A member needs care for an specific doctor but the nearest one is more than 30 minute drive from them.
Offer them an OON Waiver and Exception Request for Network Deficiency