COMMUNICATION

Expectations

100

ALL requests for updates or information from any customer -  received via any method MUST be actioned on and responded to by when?

The following business day.

200

What is the GENERAL RULE OF THUMB for follow up

Unless otherwise specified in client SAI, follow-up is required every business day up to three (3) business days in a row to collect information.

300

If the order's priority changes while being processed - the CSR must update the following to maintain the integrity of the data.

RUSH to RUSH ESCALATION

GENERAL to GENERAL ESCALATION

Adjuster/Nurse Case Manager

100

When are we required to contact the adjuster/NCM?

Missing Information Requests

Order Confirmation Notice

Authorization

Service Delays

Notice of Delivery

200

When contacting adjusters (ADJ) and Nurse Case Managers (NCM), what info do we provide so they can locate the claim: 

• Patient's Name
  
  
• Claim Number
  
  
• DOB

 

300

When calling an adj/NCM to obtain missing info - what steps must be followed? 

Determine if any information on the referral is missing as well as review Intake info entered

• Introduce Optum, yourself, and the reason for the contact.
• If another party submitted the referral to Optum other than the ADJ/NCM, provide detail as to what item/service is being requested and who submitted the request
• Request the missing information
• Provide your contact information so ADJ/NCM can reach back out to you if needed.
• Provide expectations of what the next steps are for the file on our end.

3. Document the file per documentation SOP

Document the file accurately and accordingly.  For more information, see Documentation SOP.

Patient/Vendor

100

What types of communications are required for Patients?

INTRO CALLS

SERVICE DELAYS 

DELIVERY CONFIRMATION 

200

When do we NOT have to contact the patient for an INTRO call?

Retro, vendor driven, or patient driven requests do NOT require an intro call.

300

Communication with the vendor will be required at various points within the life of an order.  These include:  

Checking Availability 

Confirming PO Received

Confirming Delivery 

Status updates

Vendor Concerns

Service Delays