Random
Who do we call out to if we won't be on for our shift?
"Taz" Tasema Nolan (or message/email her and CC your manager)
What compass direction is assigned to COV cases?
South
What tab is the care plan under in UM web?
Reviews
What is the passing score for QA?
93%
Who answers incoming calls from members and providers?
CSR or Intake
What is insurance for the insurance?
Stop Loss
Where are plan benefits found?
SharePoint, MyCare, TPA Advantage, or H drive
Where do we document all MM outreach attempts?
Care Coordination > Problem: Other
When does the case summary need to be updated?
The last 5 business days of the month
Which department reviews precertifications?
UR - utilization review
I am on the phone with a MM for 19 mins and it takes me 4 additional minutes to chart the conversation. How much do I bill?
0.4 (23 total mins)
How many SMART goals should we have for each engaged MM?
Clinical: at least 2 (one short term and one long term)
Non-clinical: at least 1
True or False: drug interaction report faxed to provider must be documented in entry AND in the care plan under Medication Adherence & Safety.
True
What is your productivity requirement?
CM - 6.4
CMC - 5.5
Which department creates cases to upload to the dashboard?
Triage
What does SDOH stand for?
Social Determinants of Health
Who do we contact for provider push back or finding IN facilities for (BAS) groups?
RBP concierge team
True or False: If my MM is not engaged, I don't fill out the MD Treatment Plan.
False! Gather tx plan information from the medical records, claims, benefit calls, provider, etc.
Stop loss (increasing the AC amount and tasking triage for groups that have SL)
What is the name of our high risk maternity team?
Nurturing Together
What is the Personify logo/mascot's name?
Percy
Where is the group AKA list found?
SmartSheet - linked on the care management home page
When do you change the engagement from "new"?
After first outreach
Which groups should we request the Benefit Focus report on and how often?
BAS groups (and select HC groups listed on the SOP), request quarterly.
Which department handles internal SCAs?
Payment Integrity