SOP It Like It’s Hot
Mary has met her hard limit for PT and would like to submit a PA for additional visits
What is Benefits and Coverage/Quoting Therapy Benefits?
Member crying about a issue they are having
What is be empathetic?
You're needing help navigating advocate central
What is Advocate Central User Navigation?
Member is requesting a POLC letter
What is POLC/COC (Active Coverage) Letter Requests - UNET?
Member just retired and calling to confirm if Medicare should be primary payer for claims moving forward
What is COB - Determining Primary Payer - Medicare?
Member just finished telling you the reason for the call
What is give hero statement?
I need to enter a Vacation Override for a member
What is Vacation Override?
Member's calling to check status of ROI on file
What is Confidentiality – Shared/Restricted Access Types?
This is where you would look to determine which plan is primary when a member has coverage under a parent’s plan and an employer plan.
What is COB - Determining Primary Payer - Commercial?
Member is receiving a bill for a amount over what UHC says patient responsibility is
What is Claims/ Balance Bill Triage?
I asked permission to place the member on hold, provide an estimated hold time and thanked the member for holding
What is hold etiquette?
Member medication is excluded
What is Formulary Look-up and Drug Coverage?
Son calls for dad to check claim details, where would i check to see what information to release
What is Confidentiality - Member Call?
John is calling to submit a Qualified Medical Child Support order?
What is Where to Submit QMCSO Information (UNET)?
Member is requesting call recording
What is Building Trust Through/ Legal calls?
Member states on call he has diabetes
What is offer Care Path opportunities?
Member claim has Reject Code 62 - Patient Name/Cardholder ID Mismatch
What is Prescription Rejections and Denials?
Before returning a call to a member, where do you check to confirm what must be verified?
What is Member Callback Authentication?
Dakota calling because his name is spelled Dakoata on his ID card
What is ID Card Defects?
Member calling about denied FSA claim
What is the Financial Advocacy/ denied claims?
Today we reviewed your benefits and discussed which providers are in network. Is there anything else I can help you with today?
What is recap the call?
Member wants to disenroll in 90 day pharmacy mail order
What is Prescription Delivery Options?
This is where you check to confirm what information can be shared when providing general information to a member
What is Confidentiality - Disclosure Definitions?
Member had questions about a disabled dependent
WHAT IS Eligibility/disabled dependent?