Workflows
True or False: If a member is calling for a new 2024 auth you should close the case for the completed 2023 auth
True
True or False: In addition to an assessment a case needs to be opened in TC for EAP
True
How does a member qualify for a TOC/COC
If a member is new to cigna plan or their previously IN provider terminated their cigna contract
On what date can we start to send eligibility/benefits requests
Starting 1.1.24 if a member or their benefits are not loaded you can send a request, please do not send any earlier
True or False: Cigna EE will get automatic approval of NER
True, if a cigna EE requests a NER for continuity of care or preference we will approve
How often do we need to offer to go over ongoing benefits?
Anytime they could be relevant, if a member is calling in the new year for services it would be applicable to offer to quote benefits
What if a member has sessions remaining on their 2023 auth
Member should use up their 2023 auth before receiving their 2024 auth and sessions
How do you determine the start date of a TOC/COC auth
The start date will always be either the day the plan started or the day the provider terminated their contract, NOT the day the member calls
In what situation would we as an advocate offer a supervisor call to a member
As advocates we should NEVER offer a supervisor callback, but of course send them through if a member is asking for one
Where are the two places is it important to document email in TC
Be sure to get a members email on EVERY call, this can be documented in demographics and in the assessment
How often is intake needed?
Intake should be completed once a year, with any new topic/auth or any time the questions seem applicable
The two things that need to be updated in demographics for an EAP reg to go through in Trucare
What is the standard time frame for a TOC auth? (how many days to request? and how many days is the auth good for?)
180 days to request, good for first 90 days of plan transition for up to 90 sessions
A supervisor callback is now part of the Universal Stakeholder Feedback form (the same form used to file a complaint)
What are the two options for who will follow up with a confide member
Confide members will get a follow up from either an LTC or a confide CC on every single call
There is now two additional queues added for 24/7 clinical navigation and support, what are those queues for
Dedicated (for Accenture, Waste management, Marriott, Piedmont) and Confide (except for Waste Management & Piedmont) and CTBH
If a member is calling regarding a 2023 auth in cams but there EAP moves to TC in 2024 where do I document?
If a member is calling regarding an old auth in cams documentation will happen in that old cams case, if they are calling regarding a new topic/auth then documentation will move to trucare
How long is an IFP TOC good for?
IFP gets 3 visits approved within 180 days
True or False: Your holiday shift will be the same as your normal shift
False: your holiday shift may or may not be the same as your regular shifts (be sure to check the AH advocacy calendar to see holiday shifts)
FREE POINTS!! Reminder, there will be 5 new accounts joining confide in 2024, they are.....
Waste Management, National Public Radio, Konica Minolta, American Eagle, & Patient Point Network Solutions
Where do we locate if a members EAP is on a plan year instead of a calendar year?
OLAM, be sure to check OLAM for this information and any other account specifics that may be listed. OLAM should be pulled at the beginning of every call
Fill out an EAP account research request and let the member know we will need to follow up with them
There are two topics based on state that get an extended TOC of 365 days, what are those two topics
Maternal MH and Terminal Illness
If a member calls regarding EAP they had in 2023 but no longer have in 2024 how can we assist?
If a member had a previous auth created in 2023 they can still use that auth until expiration date but we cannot assiste with accessing any new benefits
True or False: EAP section needs to be filled out on every call including managed care calls
TRUE, this is very important to ensure that the call receives follow up