Tell me why it's important...
Why is it important to look at the Next Steps?
The Next Steps on a need are important because it includes updates and information we are needing from the member or provider.
Who is the team lead of the Blue team?
Kimberly Dickerson.
A member calls in requesting a time-of-service payment for a service related to an eligible medical need. Who do you transfer to?
Medical Advocacy handles all time-of-service payments. If absolutely no one is available, you can contact the need processor.
List two reasons why it's important to look at the IUA Payment Notes?
By looking at the IUA payment notes we can see if the member has met their IUA, the specific bills the member has paid for, if the payment has been verified or is in the process of verification, and the date the IUA was paid.
Who is the team lead of the Gray team?
Sarah Davis.
A member calls in requesting to speak directly to Angie and go through the bills she's submitted. How do you proceed?
Attempt to contact Angie and complete the transfer; if she is unavailable and since it is not an urgent request transfer the member to her voicemail and send a follow-up message to Angie via teams to inform her that the member left a voicemail.
Why is it important to know who the need processor is on a need?
In case you receive important information related to the need and need to provide the information to the processor; in case a member has specific questions that you cannot answer.
Who is the Assistant Manager of the Needs Department who is over the following teams: Maternity, Extended Care, and Medical Advocacy?
Laura Peterson.
A member calls in to inform us that his provider will not accept self-pay patients for an eligible need handled by Extended Care. They are persistent on getting an answer, how do you proceed?
Attempt to contact the need processor; if they are unavailable transfer to their voicemail and follow with a team's message to the processor stating that the member was sent to their voicemail.
Why is it important to check the processing team?
If the need processor is unavailable and the member has an urgent question/request that you cannot assist with, you can contact another member of their team by understanding what processing team the agent is on.
Who is the Assistant Manager of the Needs Department who is over the following teams: Gray & Blue Team.
A member calls in requesting to pay their IUA for a regular need handled by our Gray team. How do you proceed?
Why is it important to view the Notes & Attachments on a need?
The Notes & Attachments on a need include document submitted by the member and provider. (Example: HIPAA Form, Itemized Statements, Payment Receipts, Medical Records, Treatment Plans) etc. It may be beneficial if a member asks if we received their document.
Who are our Medical Adjudicators?
Jessica S, Jessica P, Bethany, and Mishelle.
A member calls in with specific questions about the determination made on their need, how do you proceed?