Anthem/Health Net
Mbr says that they are unsure of what medication is due for refill. Should we code replied with acknowledgement or replied with question?
Replied With Question (Make sure to write in the notes as well that mbr does not know which medication to refill)
Mbr has confirmed they completed measure and asks you to fill out the rewards form for them, do you code mbr already attended appt or opted into benefit?
Opted into benefit
A mbr completes a partial or full survey when you find out that they changed plans, do we code changed plan or replied with survey response?
Replied with survey response - Even though they changed plans, if we code that we have to keep calling back. It is better to code replied with survey response so that mbr is taken off the next attempt, and then leave in the notes that mbr has changed plans
A mbr requests a different language that we have in office, do we code callback or leave it pending?
Leave it pending
For the CS ID box, input error.
There is a Vonage error and you are unable to even make the call, do you code error or no answer?
Error
If the number is 999999 or 00000, etc, do we code wrong number or no answer?
Wrong number - Even though we call, we know it's a wrong number, so please code as such
Mbr is incarcerated/out of town/hospitalized and will not return home for 1-2 weeks or does not even know when they will return home. Should we code callback or temporarily away from home?
Temporarily away from home
The number is no longer in service/disconnected, do you code no answer or wrong number?
Wrong Number
The call drops/disconnected or you get a prompt that says, "This call cannot be completed as dialed," do you code Error or No answer?
No Answer - Error should ONLY be used when you cannot even MAKE the call due to vonage errors
If you reached a member who was coded in the last attempt as deceased, how do you approach the call?
Let the family know to call blue shield and notify them of the member passing in order to avoid getting callbacks.
A member requests a language that we do not have in office, do we code wrong language or callback?
Wrong language
If you reached a member who was previously coded as temporary unavailable and won’t be back until next month, how do you approach the call?
If member has not come back yet, ask family member if they have received the HRA by mail and if they have power of attorney for the member they can fill out the assessment and mail it out to us.
You are calling for a gap in care/medication refill and mbr says that they do not have that diagnosis/does not take that medication, do you code declined participation or wrong designation?
Wrong designation