Warm Transfer or Conference Call
Case Management
What is Warm Transfer?
Requires to listen with the intent to understand and identify the needs of the member.
What is Active Listening?
The step taken after looking up a doctor for the member
What is offering to make a doctor's appointment while the member is on the phone?
"Are you aware of our auto-payment option?"
What is Educating the Member on Auto-Pay Option?
Horizon Dental phone number
What is 1-800-433-6825
Prime Therapeutic
What is a Conference Call?
analyze information obtained while, simultaneously, evaluating that information in order to determine next steps, a solution
What is Critical Thinking?
"Yes, Dr. Jones is in network. He's a Tier 2 provider. If you are open to seeing another provider, I can locate a Tier 1 provider and explain to you the difference."
Educate on Tier 1 vs Tier 2
"I can certainly take your payment today. Do you have your payment information?"
What is taking a payment?
Member needs info on rental or purchase for Durable Medical Equipment
What is Care Centrix's
Davis Vision (Member has vision coverage)
What is a Conference Call?
What are Examples of Call Control?
"If you have a few minutes, I would be glad to show you how to use our on-line doctor and hospital directory."
"Yes, we received your payment of $343.27 on January 15."
What is providing a status of a payment?
1-866-969-1234
What is EviCore's phone number?
Carecentrix
What is Conference Call?
To identify issues or analyze information provided by the member and using knowledge and data to effectively identify and implement possible solutions.
What is problem solving
"Are you aware that ABC Hospital is not in the OMNIA network?"
What is educating member on OON providers
"Are you aware you can update your payment information on HorizonBlue.com?"
What is educating the member on the member portal?
1-800-626-2212
What is Horizon Behavioral Health's Phone Number?
Behavioral Health Clinical
What is Warm Transfer?
This can be accomplished by taking into consideration and showing sensitivity to the members reason for calling and tone of the member/call.
What is Empathy
"You can also view your benefits online on horizonblue.com"
What is promoting member online services
"Your reinstatement is all set. I'm reviewing your claims history now to check for any eligible claims adjustment."
Pre-Service Medical Necessity and Appropriateness Review(MNARS)
What is Magellan RX