What is this
Member is upset that missed appointment
QOC
When documenting is including the doctors full name important
Yes
Member is upset that she called in and advocate was rude to her.
What would the drop downs look like? Get as close as you can.
Customer Service / Customer Service/United Healthcare phone exp/ Staff rude
Member hates the hold music
VG
When documenting is it important to provide member feelings?
No.
We want to stick to the facts of What, why, when, where.
Member says he received his EOB and there is a provider on there that he has never seen.
What would the drop downs look like? Get as close as you can.
Provider/Facility- Fraud Allegation- PCP/Specialist- They believe there has been fraudulent activity on acct.
Member is upset that provider mis diagnosed him
QOC
When documenting, is it important to add location
Yes.
Confirm the location is correct (some doctors have several offices or a facility)
Medication was ordered but still not received
What would the drop downs look like? Get as close as you can.
Pharmacy/ Pharmacy issue/ name of pharmacy/ they did not receive expected med or supplies
Member is needing their prescription covered
CD- Coverage Determination
When documenting, is it important to add the time?
Yes.
Date and, if possible, the time of the issue
Driver never showed to take member home from doc visit
What would the drop downs look like? Get as close as you can.
Transportation Ser/ Transportation late or no show/name of vendor/ the scheduled transportation ride did not show up
Member is asking her ventilator to be covered
OD- Organization Determination
When documenting, are we to add our thoughts or views on the issue?
We should be capturing only what member says. not our thoughts on it
Member is upset that her web portal is not working
What would the drop downs look like? Get as close as you can.
Customer Ser/ Technology issue/ uhc customer ser digital/online experience/ they were experiencing issue using the member website.