Systems
Calls
Wild Card
Benefits
Processes
100

A place where information about processes and steps can be found.

What is Knowledge Central?

100

"Hello, thank you for calling. My name is Ann, how may I help you?"


What is a good call opening?

100

Documentation about your calls or disciplinary actions.

What is Pulse?
100

An amount of one-way trips to plan approved locations.

What is Transportation?

100

Calling a provider due to a billing issue.

What is balance billing?

200

A place where you can find PA decisions and complete HRA's.

What is ICUE?


200

A team of SME's available to assist with questions or take an escalated call.

What is the NEST team?


200

Secondary number used to open a facets account with documentation.

What is the Family Link?

200

Funds set aside for the purchase of medical items such as band aids, Cough syrup, or vitamins.

What is Over-The-Counter?
200

Submitted on behalf of the member to show medical necessity. 

What is a Prior Authorization?

300

Where you can find Aligned vs Unaligned status and other MCO's.

What is DMEVS?

300

A note left to the main point of contact for a member. 

What is a compassion embrace?


300

A higher up responsible for assisting in chats, giving assistance with question, and taking escalated calls. 

What is a Subject Matter Expert?
300

Reviews medical history, current health conditions, diagnosis, medication, and other health questions for 45-60 minuites.

What are House Calls.

300

Searching for the navigators supervisor

What is a Navigator Escalation/ Replacement?
400

A list of plan benefits that can be accessed by the member.

What is the EOC?

400

A member not wanting to receive letters.

What is Do not call. mail, or email?

400
Phone system that coordinates with the primary phone system.

What is Avaya?

400

Contacts or frames, with standard (single, bi-focal, tri-focal or standard progressive) lenses.

What is the vision benefit?

400

Member requesting a service to be covered that is not covered by the plan.

What is a MIOD?


500

Something that only appears if there are A&G cases on file for the member.

What is the A&G tab?

500

Active listening, Showing Compassion, Acknowledging Emotion, Respect the Caller, Offer Assistance

What are De-Escalation Strategies.

500

Extra benefits that is used to increase the coverage of your group health insurance

What are ancillary benefits?


500

Deals with pharmacy benefits such as overrides and emergency overrides.

Who is Optum Pharmacy?

500

Reporting an issue that could impact health outcomes in a negative manner.

What is a Quality of Care Grievance?

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