True or False
All member ID #'s start with H
What is: False
The Cohere call opening does not need to be verbatim
What is: Yes, but you must cover all bullets in opening Ex. May I please have your full name? (Provider provides name) Could I also have your phone number just in case the call disconnects?
Specialist must ask for all two pieces of information (name/phone number) prior to offering assistance.
Intake should submit Product support issues by
What is: Creating a ticket using the Service Operation Help Desk (SOHD)
The case is DENIED, the LOB is Medicare, and the provider wants to schedule a peer to peer
What is: Post denial p2p's are only available for commercial policies, the provider must file an appeal with Humana
The link for external access to the Learning Center is____________.
What is: coherehealth.zendesk.com
A retro authorization is able to be submitted to FCR
What is: False. FCR does not accept retro authorizations
What we ask when a caller requests the authorization to be expedited
What is: Will applying the standard timeframe seriously jeopardize the life, health, safety of the member or others due to the member's psychological state, or subject the member to adverse health consequences?
We use Okta to assist Portal users for these steps:
What is: Send password reset email,
Obtain temporary password to send to user
To view if a provider is in Active or Pending status for Portal access
See user access logs
These credentials are who can we schedule a p2p with
What is: MD, NP and PA, PT, APN, DO, ARNP, APRN, CRN, chiropractor/Podiatrist.
Pending Review by Humana they would like to escalate
What is: Slack the template in the serviceops-intake Slack channel and tag the @intake-leads and @intake-supervisors
Cohere DOES NOT review requests for patients who are already admitted to the hospital (concurrent requests)
What is: True, concurrent requests are out of scope for Cohere. (WI- Cohere Delegated Scope and Cohere PAL)
The WI we use when a auth is approved and there is no authorization #
What is: FAQs - Cohere, Prior Auth, Portal
The work instruction to pull up when the provider used the temporary password provided while on the phone with you and states that it did not work.
What is: Product Support Issues - Troubleshooting and Submitting a Ticket
The steps taken when a case is in DNW and you have the provider on the line to schedule a peer to peer
What is: Put case in "pending: peer to peer review" in the portal, and slack the SR in DNW channel @tat-team
Caller states request was voided but wants to know why.
What is:Check CGX (or you may need to reach out to someone who has CGX access). uploaded as an attachment
Prior Authorizations can be withdrawn by Intake Specialists without provider permission for any reason.
What is: False
A provider previously submitted a DI&S request through HealthHelp and wants us to edit the authorization for them
What is: Let provider know Cohere Health will be Humana’s delegated vendor for Diagnostic Imaging & Facility Based Sleep Study prior authorization submissions come July 1st, 2024. If any changes or updates need to be made we would have to submit a new auth
The WI to use if a user's Portal account is locked
What is: Identifying Users in Okta
This is where you post out when editing the information on a p2p that has already been scheduled (Example: Provider wants to update phone number)
What is: Post in the intake channel and @Gatekeeper
A caller is requesting a peer to peer and there are no available times via p2p gatekeeper
What is: keep the caller on the line if possible and post out to FCR. obtain all necessary peer to peer scheduling information from the caller and work with FCR to find an available time.
According to the HIPAA Authentication Grid, you can obtain the patient's name OR DOB for the 2nd authenticator.
What is: False, you must gather both. Alternatively, you can also gather the providers NPI number
Where the workflow post is for a provider wants to edit the dates of service on a previously approved authorization
What is: FCR - Workflows - DOS change only
The 3 main sources of communication that we need to have open during our workday
What is: Slack, Zoom, Schedules.
The amount of time before DDBD we can schedule a peer to peer for a medicare case/commercial case (two answers)
What is: Medicare is 2 hours and Commerical is 4 hours
The options we can give a provider when a case is pending MI and the caller states they don't have any additional MI to submit
What is: offer more time to submit the MI, withdraw the case and have them resubmit when the info is available, move forward with an MD review as is, or schedule a peer to peer