Turn Around Times
Documented by 2 Business Days from date was case assigned/activated.
What is initial research.
TAT for care plan to be entered on HR/complex members.
What is 1 business day.
A member who meets these criteria.
Greater than $50K total spend last 6 mos * Greater than $150K total spend last rolling 12 mos * HICO DGA identified in most recent monthly info Opp Packet * High Dollar Forecast DGA entered
What is a high cost claimant?
Indicator for automatic pharmacy referral
These types of members have their PSE outreach done by care managers.
What are high risk
2 attempts on different days and times within 14 calendar days of previous call.
What is follow up call.
SMART goals stands for.
Specific, measurable, accountable, realistic, time-bound.
In addition to the research template, this is added to all identified high cost cases.
What is the High cost template?
When re-documenting research and transitioning to initial outreach template is required.
What is transitioning from non-complex to complex level of care.
Person who's task list the CM will send PSE's to that are to be completed by the PSE team.
Who is Shae Super
2 attempts on different days and times within 14 business days prior to admit date.
What is a Pre-admission call.
applicable to member's case/condition and described in statement form to provide specific gap or need.
what are Barriers
The threshold to send case for Team Lead review.
What is 100k.
High risk and HCC types of these can be delegated.
Provider outreach
When PSE outreach can be deferred.
What is when the member has been successfully outreached in the last 180 days.
Complex / High Risk Opportunity. Initiate within 30 calendar days of Complex / HR result date in the opportunity packet. Complete within 60 calendar days of Complex / HR result date in opportunity packet.
What is triage assessment
All goals must include what from the member.
What is acknowledgement.
Threshold for sending to supervisor for review.
What is 250k
MD consult turn around time for an engaged RAP member.
What is 1 business day of engagement.
Team outreaching for breast biopsy PSE's.
What is the PSE team.
Best to initiate this assessment on date of engagement. Completed with all engagements
What is BH assessment
High Risk care plans are to be updated every (_) days regardless of speaking with the member.
Requirement for all cases over 500k spend
What is take to MD rounds or MD office hours.
is required for all RAP cases that have unscheduled re-admissions within 30 days of discharge date, regardless of engagement status within 1 business day of CM receipt of notification
MD notification.
The place to find workflows and education on all PSE's.
What is the share point, under the a1a proactive service engagements tab.