SLAY
This intent is used for locating providers for our member.
What is Search and Assign Provider?
If you want to see if there is an OD already on file where else besides Maestro can you see this information
What is ICUE?
This tab in ICUE you click on to see if there is an OD already on file for a member
What is HISTORY?
This person does not need the member’s permission to do anything and everything that the member can do themselves.
What is POA/Guardian/Conservator?
If someone calls in and they have not be verified through the IVR this SOP will help you determine what needs to be verified.
What is HIPAA Index?
This pieces of information needs to be verified in HIPAA.
What is Full name, member ID and member DOB?
information needs to be verified for all callers whether using the IVR system or not
This must be done if the member came in authenticated.
What is Acknowledge that they came through the IVR?
A broker is calling and you share information with them.
what is Basic Plan, Member Enrollment, Member Claims, and Premium Billing information. You can share everything except for sensitive and member medical information.?
When making an outbound call to the member these are some things that you are required to disclose to the member.
what is Tell them your name, state you are calling from UHC and on a recorded line?
If a member is calling in about something do you have a choice as to whether or not you quote their benefits?
No
member is calling in because they need to have blood drawn and want to know if it is covered and how much will it cost them, this intent is what you need to open to give this information.
What is Review Medical Benefits?
When member is calling about paying a utility bill and this utility bill is not covered.
What is Phone Bill?
This is if someone is needing to locate resources for things like food or help paying for electricity or housing.
What is FindHelp/Aunt Bertha?
before you give out any of the member’s information you must make sure that you do it.
What is GET THEIR CONSENT?
you call a Medicare Medical Prior Authorization.
What is Organization Determination or OD?
This intent is used to file complaints.
What is CAG?
these systems are used to file an OD.
what is Maestro and MIOD?
the difference between Part B and Part D drugs
The setting, Part B drugs are administered to you by a professional and in a medical setting.
the 3 levels of Medicaids.
What is Full, QMB Obly and Partial?
The grace period of being partial medicaid before losing completely medicaid.
What is 6mons grace period?
a member disenroll their plan during this time.
what is When the plan is active and during a valid enrollment period?
Determines how much member will pay on a Brand or Generic drug.
LIS Level
What is Quality of Care Grievance?
The type of call we can treat as if they are the member calling.
What is POA / Guardian?