Back to the Basics
When using a status reason Advanced Find, it can only search one status reason at a time. (True or False)
False. You can search one or multiple status reasons using one Advanced Find.
Recruiter's are required to save and store their applications in their Odrive folders. (True or False)
True!
What should be pulled up prior to making calls for the PCO, aside from CRM?
The health plans CSFS and Launch Notice (if applicable)
If a provider says they aren't interested but didn't share why, what can you ask to get them to share more?
Possible answers:
May I ask why you aren't interested?
Do you have any feedback that we can share with the health plan?
Where can you find the due date for discrepancy? What was suggested do with this date to get organized?
Compensation Timeline located on the Application Credit Dashboard on SP.
Add the discrepancy due dates to your Outlook Calenar.
Which Advanced Find template would you use to search all rehab leads assigned to you in a certain campaign?
Rehab Campaign Report
Recruiter's are required to use the Application Sent and Application Submitted tracker templates and follow the SOPs exactly. (True or False - Explain your answer)
False. Recruiters are encouraged to use a tracker for both their sent apps and submitted apps, however, it is not required to use the provided templates. Recruiters can use their own version as long as it tracks the same information.
What are three things to be mindful of when calling providers, not including messaging?
1. Tone
2. Pace
3. Clarity
Scenario: You have a provider in a high priority campaign. They explain they will not join due to rates. After gathering information you've determined they are someone we likely will negotiate with based on campaign and other criteria. Where can you submit their request?
Rate Request Form on SP
How would you explain Choosehealthy and Seamless Accounts to a provider?
Choosehealthy: Cash based discount program.
Seamless: This plan gives members reciprocity when traveling. If they travel to another state or reside in another state, they'll be able to use their in network benefit if the provider is par with this plan through Seamless Accounts.
What is wrong with this recruitment link email?
(45 seconds)
1. Highlighter happy
2. Says 'attached app docs' when app docs were not attached.
3. Signature was not moved into the email
After submitting a standard application, sending out the confirmation email, and making sure the CRM lead meets minimum necessary, what should you do next?
Update your personal Apps Submitted tracker to keep track of the submitted application.
You're calling a DC in an underserved area for a health plan campaign. What additional talking points would you use to pique their interest and give you a call back?
Benefits of joining ASH
Different plans we administer
Membership information or appeal to treating members in need
Which specialties are tier levels applicable to?
1. Acupuncture
2. Chiropractic
3. Rehab Services
What 5 things should be checked on PLI to ensure that it meets standards and requirements for credentialing? Bonus 100 points if you can name a 6th item that may not always appear on the PLI but if it's there, it should be checked.
1. Policy Period
2. Policy Limits
3. Name
4. Specialty
5. "Professional" liability
Bonus: Facility name matches the facility name on the application.
What would you do if you wanted to target a non-rehab 2 for 1 campaign in CRM?
Create a new advanced find using the Non-Rehab Campaign Report Advanced Find. Enter in the campaign and then save.
What are the 4 Outlook organization tips that were covered?
1. Creating folders in Outlook
2. Color coding emails
3. Creating rules
4. Changing 'read' settings
What are some things you can add to your messaging when sending the recruitment link for the provider to review?
1. Check spam or junk
2. Link includes CSFS, ops manual, and agreement
3. How long it will take to send the information and application to them
4. Set a date to follow up with them.
A provider explains they do not currently take insurance. How could you respond to this? Why?
Do you have any empty spaces in your schedule?
If they do have empty spaces, you can explain that they could fill those empty spaces with these patients when they otherwise wouldn't have recieved any payment.
How could you search on SharePoint, whether it's our SP page or another departments, to find information to answer a question (yours or the providers)?
Enter a keyword into the search bar on SharePoint. If you're on our SP page, this will only search on our site, but if you're on the Flash it'll search all of SharePoint.
What are the three factors that are considered when determining a duplicate lead?
1. Date created
2. Campaign(s)
3. Activities / First Contact
Why should complete and incomplete applications be saved in your Odrive folder? Can you give a scenario?
They should both be saved in the Odrive folder so they can be accessible to anyone should you be out of office and we need to access their complete or incomplete application.
Scenario: You have a DC in Washington in the Cigna PNW campaign. They mention they are not interested in joining due to MNR. You explain that Cigna allows for 15 visits before MNR is required which leads to them completing the application, but they'll be opting out of Aetna and Centivo which have campaigns in the lead. What would need to be done in the CRM lead to reflect this?
Update the status and status reason on the Campaign Trackers tab for Aetna and Centivo to close as Not Interested | MNR Requirement
How would you address a DC providers concerns about MNR? What information could you share about MNR to possibly change their mind?
Explain that MNR is a one page document that will be peer to peer reviewed. In the MNR they'll include their request for the number of visits they feel are necessary to treat the patient. The like specialty clinician will review and respond within 24 hours with the data used to come to that determination as well as their extension for any questions.
You have a NS provider call into the queue requesting an application. They mention they practice in two different states, Arizona and Florida. There are open leads for them in both states. How do you proceed?
Ask what state they reside in and explain we can only credential them in that state. We do not currently credential NS providers for telehealth. The lead they do not reside in will need to be closed as Ineligible | Facility Requirement.