Call Miner/ World Class Score
Can you still receive points for using "Trusted Healthcare Partner" in the closing of the call.
No. The language has been updated to "Partners in Care"
Do Continuous Glucose Monitors require a Prior Authorization?
Yes
The Coordination of Benefits Department handles Dental Claim Adjustments?
No. You would request a Dental Claim Adjustment through a CCD cut.
True/ False: Employees will automatically have a lower deductible in 2024?
True
True or False: Military Leaves can be entered Intermittently or Continuously?
True or False: Military Leaves can be entered Intermittently or Continuously?
True or False: We do not have to offer the paperless communication if a member is already enrolled?
False. We should still thank them for enrolling by using one of the phrases:
• “I see you have opted in for Paperless Communications, thank you for doing so!”
• “I am able to confirm you have opted in for Paperless Communications, thank you for that!" There is no limit on mastectomy bras
How are Hearing Aids covered?
They are not covered!
Any UPMC provider can write a script for Ozempic and it will be covered?
No. Ozempic is NOT covered as weight loss medication unless it is ordered by a provider participating in the Weight Loss Pilot Program
In the first 3 drawings, How many winners will be chosen?
30 Winners
If an Employee needs their AFLAC form filled out, who do we connect them to?
Employee Service Center
Name 3 pieces of the World Class Call Score.
Introduction, Provider Advocacy, Web Mentions, Paperless Communications, Positive and Negative Empathy, Closing
Premium breast pumps are covered 100% if you go through Milk N Mamas Baby Suite?
False. Not covered at 100 percent like the standard electric pump
True or False: Colonoscopies are covered only for members 50 years of age and older.
False. No cost share for members aged 45-75
Do the reward cards for TAHS expire? If so, when?
Reward cards will expire 6 months after they are issued.
If a Leave Specialist &/or STD Adjuster is needed and not available during the call, what should we do?
We will now add a “To-Do” item under the case in question and no longer send a follow up email.
What is the Goal number and Stretch Goal number for Healthy Connections?
Goal is 30 and Stretch Goal is 35
Where would you look to see if a Custom Orthotic is covered?
A) Schedule of Benefits
B) MCN Policy Manager
C) Call RU
B) MCN Policy Manager
How long does a member have to submit a parking and transit claim?
Members must submit claims for the Parking and Transit within 180 days of the date of service.
For the Grand Prize Drawing, What is the last day to have the points completed by?
Thursday, Nov. 30
True or False: Employees can setup an ADA or SAW claim for their spouse or child medical conditions.
False. It has to be the Employees own medical condition.
True or False: You will only receive Provider Advocacy credit if a member accepts your scheduling offer.
False. You can receive the credit for Provider Advocacy even if the member says No.
Lift Chairs will apply towards a member's deductible and coinsurance?
Only the “lift mechanism” of the lift chair is covered. The member is responsible for the cost of the chair as it is considered furniture.
True or False: When filing an appeal for a member over the phone, we would do so using the CCD topic Complaints/ Grievances.
Use the My Health Online Impersonation Tool to file an appeal for member through the appeal submission determination request form while the member is on the line per request.
How many days does an employee truly have to complete the Questionnaire?
60 days from the coverage start date
What is the difference between an ADA and Saw Claim?
ADA- Employee has a chronic, life-long medical condition which impacts their ability to perform their position.
SAW- Employee has temporary work restrictions for their own medical condition.