Workflow
What are the HIPPA identifiers to be used during every outreach, and how many are mandatory?
You must verify a total of 3 HIPPA identifiers from the following options:
•Full Name
•Date of Birth
•Member ID number/ Medicaid ID number
•Member Address
COS door-to-door requests should be sent in Jiva for which enrollees?
Enrollees who have been unable to reach after phone attempts and UTC letter and are top 1%, High PICS, or High risk based on clinical judgment.
What is the name of the web-based application where you can find an updated phone number and review recent ER visits?
CRISP
What is the current policy for unplanned PTO or alternate work location request?
Send an email to leadership with unplanned PTO or request for alternate work schedule/location details.
At the Maine Ave. Location, how many conference rooms are available for use?
3 (Large Conference Room, Executive Conference room to the left of the security desk. There is also a smaller conference room by where Shai sits.
What is the time frame from identification date to first outreach?
1-3 business days from referral date for those who are identified as HIPICS, top 1%, urgent referrals and inpatient admits. All other referrals within 5 business days.
Who is the manager of Utilization Management?
Mellisa Wallace, RN: Manager, Utilization Management mwallace@amerihealthcaritasnh.com
After verifying an enrollee has successfully or unsuccessfully accessed a community resource, what platform is used to document a closed loop referral?
Findhelp. https://acdcstaff.findhelp.com/
You can “close the loop” by updating the referral status through the “People I’m Helping” Dashboard
What is the same day requirement prior to a scheduled case management face-to-face engagement?
CM must call one day prior and on the morning of the face-to-face visit
How do you submit an extension request for Mom’s Meals?
You must complete a new referral form, designate that it is reauthorization request and send to BOTH CTINTAKE@momsmeals.com as well as acdc-ext-momsmeals@amerihealthcaritasdc.com. Leadership will review and approve or deny extension request.
What is the one mandatory goal in a Care Coordination plan of care?
Mandatory Goal: Complete General Care Coordination Pathway.
Who is the ACDC BH Medical Director?
Dr. James Andrew Murphy
What platform is used to complete Performance reviews and how do you get there?
ePerformance LINC | Insightà Associate Centerà Performanceà Performance Home
What is the next step for a Care Connector/ Peer Recovery Specialist who receives a death notification from a family member or caregiver (multiple steps)?
Care Connector/Peer Recovery Specialist/COS Team Member
What ACDC staff member do you notify via email if an enrollee has moved out of state?
Shelly Thompson: sthompson2@amerihealthcaritasdc.com
What is the time frame before an episode is considered overdue, both Care Coordination and Complex?
Care Coordination: 3 months and Complex Case Management: 6 months
What ACFC team will support enrollees with finding in-network providers, booking appointments, and connecting to community resources?
Rapid Response Outreach Team
* You can send activities in Jiva to Rapid Response (Worklist)
What is the name of the guiding ACFC document that ensures secure use of PII and PHI?
Acceptable Use Policy
How do we have documents translated into large print, or audio recordings for our visually impaired enrollees?
Submit document translation requests via SECURE email to production@acsitranslations.com
Find more information: ACSI Translation Braille Large Print Audio Tape Services Guide 3-21-2023.pdf
What assessment needs to be completed for every complex episode within 60 days of identification date?
Condition Specific Assessment.
Who would you contact with any IT Desk related concerns and is on-site at Maine Ave office?
Luis Rodriguez, Desktop Services Associate – IT, AmeriHealth Caritas DC |
lrodriguez4@amerihealthcaritas.com
Which platform is used to manage and review retirement benefits?
You can navigate to the platform through Insight--> Associate Center--> Benefits--> Amerihealth Caritas Empower Portal
As outlined in the Acceptable use or Disclose PHI policy, we must obtain a written authorization signed by the member prior to disclosing PHI. What platform is used to obtain written consent?
Consent Management
What team can you call to support enrollee with a pharmacy issue?
Pharmacy Enrollee Services Line; Perform Rx; ACDC Pharmacy Director Tracy Davis