Common Audit Opportunities
During what months of the year does a CN ask the member for Flu shot info?
What is August to April?
What must we do on every 3rd party call?
What is advise the call is being recorded?
If we are calling the Authorized Representative on a quarterly outreach, what must we do first?
What is make sure the Authorized Representative is still listed with Member Services or validated in I-CUE?
I was a professional Belly Dancer for 10 years that started during my college days.
Who is Elizabeth?
What can we use to check member’s plan benefits?
If a member's sub-status is DNC, how many times do we reach out for a Nurse Line follow up task? How many times if the member's sub status is UTRed/Loss of Contact?
What is
If DNC, we do NOT reach out
If UTRed/Loss of Contact, one attempt only?
If you have provided a member a specific specialist name and number, what option would you select in PW under "referrals made"?
What is General?
If the member declines a FTF visit but agrees to a quarterly telephonic contact, what is the proper sub status to select?
What is Unable to Engage?
My middle name goes back 4 generations and I'm the first girl to have it out of all of us.
Who is Kelsey G?
Systems used to check for alternate phone numbers?
What is ICUE, Nerve Center, Clinical Profile, and DMEVS?
What two outreaches do we confirm the name of the member's PCP and offer to schedule a follow up appointment with the PCP?
What is
the initial call and every 90 day follow up?
If you provide food, utility, and lawn maintenance resources, what do we select for the referrals made?
What is food, utilities, and general?
2023 UHC transportation vendor for Washington
WHAT IS SAFE RIDE?
I am the only college graduate from my family on both my mom and dads side of relatives.
Who is Kelsey C?
This tab in Pathway is where ALL tasks are listed in chronological order.
OPEN ACTIVITIES IN MEMBER DETAILS SIDE
What are all options available to fully HIPAA verify a member?
FULL NAME (FIRST/LAST), DOB, AND ONE OF THE FOLLOWING Address (authentication may occur with number (including apartment number), street, and city/state OR number (including apartment number), street, and zip), or Subscriber ID, or Last 4 numbers of SN
If a 3rd party tells us the member is not interested in the OAH program, what is the appropriate disposition to select for the "Outcome?'
What is Unsuccessful?
What are the 4 reasons for a case closure?
What is
-MEMBER DECEASED
-LOSS OF ELIGIBLITY
-OPT OUT
-HOSPICE MEMBER
I cannot donate blood because of Mad Cow Disease.
Who is Meghan L?
This system is used to check engagement for members with LMH in Supplemental Service.
Landmark Health Portal
What are the 5 main things the CN says to the member before ending the call?
What is
1. provide/offer callback number & extension
2. provide/offer Nurse line and MS (on the back of the card)
3. ask for any questions from the member
4. summarize key details of call
5. let the member know the timeframe/date of the next call and next steps?
What resource can assist with selecting the correct Subject, Outcome and Referrals in a communication note?
what is ACTIVITY TAB IN CN DOC TOOL
How does a CN facilitate closure of the AWV open Star Gap?
Offer to help schedule the visit
I went to school to be a paramedic.
Who is Karla Arana?
What are the 4 requirements to report emotional/physical abuse and what is the timeframe?
What is
1. Submit to the Complaints & Compliments Issue Mgmt SP
2. Call the local abuse hotline
3. Document Safety Concerns as Outcome in PW
4. make sure to document the Ticket Number for future reference
SUBMIT WITHIN 24 HOURS OF RECEIPT OR IDENTIFICATION (WHENEVER POSSIBLE