Health Plans
Where can you locate the "Health Plan Guide"
SOS Resource Guide
Within how many minutes do you have to say the FCC statement.
1 Minute.
What do you have to ask for when verifying PHI
DOB and Complete Mailing Address.
How many marked domains do you need to move a child's case on?
2
What do you have to do the Friday BEFORE pay day.
Validate your time sheets!
If a member is NOT in Compass, and the Health Plan Guide says "YES" you can create a profile, what do you do?
Add them to Compass!
If you do not speak Spanish, what do you need to do before calling Voyance?
Reach out to our Spanish Speakers to see if they are available to take the call.
What are 2 phrases for Politeness?
In the MDIs where does "frequency" go?
Symptoms?
How much OT can you work right now?
Unlimited!
If member calls in, and is NOT in Compass, and the Health Plan Guide says "NO" you can not create a profile, what do you do?
Advise them to call their health plan.
If you complete a full screen start to finish, what Term Code do you select?
"Accepted Case"
What is Symptoms?
Examples of Physical symptoms:
-pain, fatigue, swelling, joint stiffness, weakness, numbness, shortness of breath, cough, nausea, etc.
Examples of Mental symptoms:
-low mood, crying spells, low motivation, loss of interest, mood swings, short temper, nervousness, panic attacks, obsessions or compulsions, nightmares or flashbacks of a traumatic event, memory problems, attention or concentration problems, inability to handle stress, etc.
What is a passing score on audits
<92%
What is PFK and do we work with them?
Partners For Kids - YES! Tomara gets the referral and uploads it, the plan then has the "OK" to call, so we know we WILL have that case.
If you started the screen, but the member has to hang up, what do you select?
Incomplete Screen
What do you ask for during third party?
What is Functional Limitations?
Functional limitations are defined as "reduced ability to do basic work-related physical and/or mental activities." Functional limitations are caused by symptoms of a MDI and can result in reduced ability to do...
Physical functions such as
-Exertional: sitting, standing, walking, lifting/carrying; pushing, pulling, reaching, or handling;
-Nonexertional: postural (position) – bending, stooping, crouching, kneeling; senses - seeing, hearing, speaking, touch/feeling, etc.
Mental (nonexertional) functions such as
-understanding and remembering simple instructions;
-maintaining attention and concentration to carry out tasks
-use of judgment;
-responding appropriately to supervision, co–workers and usual work situations; dealing with other people; and
-dealing appropriately with changes and stressors
As an SOS Tier 1, what do your accept average and attendance have to be to earn $800 bonus?
5.0 Accept Average; 100% attendance.
Parent calls in and states they have Anthem Insurance through her employer. They do not have any Medicaid insurance. What do you do next?
Offer fee agreement.
ANY Foreign Language Call needs to be coded this.
Does Not Speak English
Give me 1 reason why Call Miner may grade your call wrong.
1) You werent speaking clearly
2) You coded your call wrong.
Where does height and BMI go in the screening?
Support Notes
How long do you have to be here and out of ramp up to start qualifying for an SOS Tier 2?
9 months.