Misc.
Is there a cost-share/co-pay for members to have a HouseCalls visit?
No, There is no additional cost for this program to our members
What does AEP stand for?
Annual Enrollment Period or Annual Election Period
What is the United Experience Survey (UES)?
A 3 question survey members may opt to take at the end of every call
Which website would you use to assist members in locating resources in their community?
Findhelp
What does it mean when you get a One Breath call?
Member is in danger, or a member has made a threat to harm themselves or others
Which Maestro tab shows you past S-cases and I-interactions?
Recent Interactions tab
What is a QOC grievance?
QOC complaints occur when services received by a member from a medical provider / facility or pharmacy are inadequate or substandard in quality.
What does DEC and MRC stand for?
Disenrollment Enrollment Cancellation Team, Member Retention Concierge
What KC Job Aid would you use for dedicated EG's?
High Profile Employer Groups - Index
What is the TAT for replacement ID Cards?
Allow 7-10 business days for members to receive their replacement ID cards.
What is the only type of information you can give without authentication?
Basic Plan Information - Information that is available to the public
What intent would you use to update member name/dob?
Update Member Profile
What is the website to search for Behavior Health providers?
Live and Work Well
What does SCC stand for?
State and County Code
What intent would you use to send Provider Directory?
Member Materials
What does CAHPS survey stands for? What does this survey measure and how often is it sent to members?
CAHPS stands for Consumer Assessment of Healthcare Providers and Systems. This annual survey measures a member's experience with their health plan and care providers.
What are 2 places we can look to find a members deductible?
iBAAG, GRIF, Maestro summary tab
Which address is the highest priority?
Mailing
What category and intent would you use to check application status?
Application, Review Application Status
Member is upset his routine acupuncture isn't covered, what grievance category and subcategory would we use?
Plan - Plan Benefits
What system is used to for searching and reviewing documents/letters received by members?
View Document System
What are 3 examples of the Preventive Services NBA that you would see in a members account?
Annual Physical and Wellness Visit, Breast Cancer Screening, Colon Cancer Screening, Diabetic Eye Exam, House Calls
What tab in the members account would we find Medicare Claim Number (Medicare ID)?
Member Tab
What is the turnaround time of a standard Organization Determination?
14 days
How long do members have to respond to a PDP2073/PDP2490 before receiving a 'OOA Permanent Move Termination Letter'?
6 months