General
Who are member guides responsible for issuing urgent care referrals for, over the weekend?
All members:
For Firefly Health Plan members: issue a care key
For non-Firefly Health Plan established patients: send a recommended location as a referral
Who is eligible for an urgent care, care key
- Coverage only members (primary subscriber + spouses)
- Coverage only members (dependents)
- Care+Coverage only members (dependents)
What is the name of the section of lucian where you search for providers and facilites
What is the difference between an urgent care referral and an urgent care, care key?
Urgent Care Referral: This guides members to a recommended urgent care. This should only be used for NON Firefly Health Plan members. Standard Urgent Care Copay will apply.
Urgent Care, Care Key: This guides members to a recommended urgent care, and issues a care key in app so care key urgent care rates will apply ($0 for all plans in 2025)
Who is eligible for an Urgent Care Referral (not care key)
Before searching the provider directory, what should you review to see if it is an appropriate referral option
Automated suggestions
After entering a referral - you will be prompted with automated suggestions in blue, if there is a Firefly Nearby partner available for the member.
How will you receive a request for a urgent care referral (for non-Firefly health plan members).
Clinician receives page from member and creates a referral, and then creates a CCA which alerts you to create a referral for the member. You will need to check the member insurance to confirm that the member has a non-Firefly Health Plan insurance.
- If the non-primary subscriber wrote in requesting the care key. Please close the loop and let them know that a message was sent to the primary subscriber with the location information.
If a partner if not available in the automated suggestions, what should you search in the provider directory:
1. move to the procedure search in the provider directory
2. search the global urgent care cpt code (type in global urgent care cpt code)
3. A recommended location will surface within 25 miles of the patient. If there is no recommended location within 25 miles send a neutral location.
How will you receive a request for an urgent care, care key?
1. Clinician is paged by a patient, they create a CCA alerting you to create a care key for the member. You will need to confirm members insurance, in order to know if you should issue a care key
2. Member writes in via the app and instead of creating a CCA for the care navigation team to create a care key you will create an urgent care, care key.
When you create a care key for a dependent, whose Lucian profile do you create the care key from?
The dependent
*note: the primary subscriber will also be able to see the care key.
What is best practice to do before you send the member to the location and add the location to the care key or referral?
Google it...confirm the location is open on the weekends, confirm the services the patient needs are offered by the urgent care (use your common sense and best judgement, would you send your relative to this location for an urgent care need)
When is it appropriate to send member to a Firefly Nearby Location? Who pays for a Firefly Nearby invoice/claim and how much does it cost the member?
1. Any member who receives primary care services through Firefly this includes Care+Coverage and Care only.
2. Firefly Medical Group pays for the service, and it is $0 to the member. Firefly Nearby partners and the services they offer are considered an extension of our primary care.
Can you send a Urgent Care, Care Key request to a Firefly Nearby location?
- Use the correct macro
- Toggle care key off
Or Call Sara 781 964 2244