Systems
Online database of resources that are available in the community and nationwide
What is finhelp.org(Aunt Bertha)?
Through this program, health care practitioners make in-home clinical visits with members to evaluate their health conditions. The program is designed to educate and help our members. This visit is meant to support the care the member receives from their primary care provider. It does not replace their regular PCP visits or the annual wellness exam. There is no additional cost for this program to our members.
What is HouseCalls?
This intent is used to send out fulfillment items such as an ID card or an Evidence of Coverage.
What is Member Materials?
This Job aid will help Advocates determine how to begin each call & how to close the call
What is Greetings and Closings - Index?
This intent is used to review members Part D benefits.
What is Review Rx benefits intent?
This system houses your resources & job aids for processes
What is Knowledge Central?
This is a Medicare requirement that provides the plan with health-related information about members.
What is Health Assessment?
This intent lets you update the permanent, mailing or temporary address
What is Update Member Address?
This job aid will provide C&S DSNP Advocates details regarding the use of the Review Medical Claim History intent in Maestro including the NEST escalation paths.
What is Review Medical Claim History Intent (C&S DSNP)?
This job aid is used as a starting point for any LIS questions or additional information on LIS.
What is LIS - Index?
This system is used to complete a health assessment.
What is ICUE?
This Next Best Action assists the member in taking this preventative care by scheduling a colonoscopy or providing education regarding the iFOBT kit.
What is Colon Cancer Screening?
This intent is used to locate & change a PCP for a member along with finding facilities & specialists
What is Search and Assign Provider?
This index is to help locate resources while handling calls for DSNP members.
What is DSNP Advocate - Index?
This system is used when we want to submit a coverage determination for medication.
What is Prior Authorization Technician or PAS system?
View member eligibility and Medicaid provider when Medicaid isn’t with UHC
What is DMEVS?
This Next Best Action encourages women to take an active role in scheduling their breast cancer screening by scheduling the member directly with a facility.
What is Breast Cancer Screening?
This intent is used to review medical claims.
What is Review Medical Claims Intent?
Within this job aid, there are tips to identifying and handling grievances along with how to categorize them for documentation
What is Grievance Handling?
This intent is used when you want to review claims for pharmacy.
What is Pharmacy Claim History?
This is our main system we use on a day to day basis when it comes to member information & documenting what the member is calling in about.
What is Maestro?
This is an opportunity for members to have their health assessed by their doctor and develop a plan of care that fits their needs.
What is Annual Wellness Visit?
This intent will provide us information regarding members benefits along with medicaid level
What is Review Medical Benefits?
The job aids within this index provide the requirements and guidance for properly authenticating the caller and protecting the privacy of our members.
What is HIPAA - Index?
This intent is used to look up the members formulary for drug
What is Formulary Lookup?