ISM

Call Flow

100

This is the act of repeating key details back to the member to confirm understanding.

Recapping

200

This shows understanding and concern for the member’s situation.

Empathy

300

This step explains available options to the member before closing the call

Offering ISM suite of services

Metrics

100

This metric tracks adherence to scheduled work times

SCAD

200

The Metric for Scad

94%

300

Evaluates the quality of interactions based on predefined criteria, such as colleague professionalism, accuracy, and adherence to scripts or guidelines

ACE

400

This score is measuring the likelihood of the member recommending our services to others.

NPS

PHI

100

This should be done before discussing account-specific details with a member.

Verify the member

Resources & Tools

100

This resource should be used when you are unsure of a process or policy

E.Policies

200

A resource that should be pulled on every call for plan specifics 

PSPP

Infosys

100

Remains Not Covered

Weight Loss Medications

200

Sort doctors and facilities into tiers based on their performance and ability to save money.

Multi tier plan

300

Must be within 25 miles of the members home,  a tier 1 (Maximum Savings),  provider is accepting new patients, and correct provider role.

PCP Choice Criteria

400

a benefit that provides each enrolled member up to 5 services from a pre-defined list of in network services covered at no-cost (100% paid) prior to the application of the deductible and/or coinsurance.

Flexible Five

500

Non-emergency charges incurred outside of the United States, Home births, Cancelled or missed appointment charges or charges to complete claim forms, Services for or related to the following types of treatment: aromatherapy; sensory or auditory integration therapy; primal therapy; rolfing; psychodrama; megavitamin therapy; bioenergetics therapy; vision perception training (vision therapy); or carbon dioxide therapy

Plan Exclusions