ESCALATIONS
Member is calling in upset and states they want to speak with someone else/superviosr?
KA 303- Individual Caller Request to Speak with Supervisor/Escalated Calls
FL member calling for home health aid and physical therapy at home. What KA would you follow?
KA-4390 Home Health Care- Carelon Post-Acute Solutions
Fl member calling to find a cardiologist in her area. What KA would you follow to see if PCP is capitated?
BONUS: Where would you go to see a list of capitated providers for that vendor?
KA -3202 Florida Medicare -Evolent Soeciality Services (Oncology, Cardiology, Cardiac Surgery, and Hematology)
Answer: Wikitool- FL Delegated Vendors-NCH Monthly Roster
Member is calling in because they received a letter due to loss of Medicaid.
KA- 3672 Dual Eligible Loss (Recertification) of Medical Coverage
Member is calling because they have a cardiologist appointment tomorrow and are needing to schedule transportation. They are wanting to know if they can get a short notice override.
KA 4363- Non-Emergency Medical Transportation (NEMT)
KA containing FAQ link pertaining to rollover requests?
KA-4311 2025 Extra Benefits Card offered by CVS Health Overview
Member is calling because the 30- day standard TAT for an appeal will jeopardize their health. Which Ka would you follow?
Bonus: What is the TAT for an expedited appeal?
KA-2825 Expedited Appeals
Answer:72 hours
FL member is calling to locate an optometrist in their area? They are also confirming that they can see a Bascom Palmer provider. Which KA would you follow?
KA- 4333 2025 Florida Medicare- iCare Vision
If member is calling in regarding application status, which KA would you follow?
KA 3584- Call Handling Application Status
Member is calling to report they have completed their healthy home visit. In which KA can you see the workflow for attestations?
Bonus: Do we need to confirm they have completed any activities?
KA- 4391 2025 Your Healthy Rewards & Aetna Healthy Rewards