Timelines and Priorities
Ticket must be opened/viewed and ________, ___________, Tax ID, Member ID, and any required fields updated.
Categories, Subcategories
This information is extremely vital to get on our requests ASAP. It helps when searching for duplicates, or merging/linking similar reqeusts/TINs.
Check for and ______ duplicate tickets.
Merge!
Please remember this is a VERY important step. We want to avoid duplicate work and make sure we notate/keep track of duplicate requests.
What should be sent immediately upon opening, viewing and starting a Health Plan request?
Confirmation Receipt!
We want to send a confirmation receipt ASAP to inform them we are working and provide weekly updates until a resolution is determined/implemented.
Each team member is allotted _ ____ weekly to be on Not Ready in the phone queue for special work.
1 Hour
Team Members must close at least __ substantive tickets per week?
25!
This does not mean we aim for 25 total tickets, we should be aiming higher! We may have special projects, but we also have opportunities to organize our week to pickup and work some easier, less labor intensive requests to help keep the box manageable.
Most requests _____ be _______ within 2 weeks of starting work unless external delays occur.
should be resolved
We understand there are exceptions to this rule, however most issues that are presented to us can be completed in that timeframe.
When first starting a Ticket, the "Due By" date should be set to the Friday how many weeks ahead?
2 weeks!
Remember, whether you pickup and start working a request on Monday or Friday, it will still be set to the Friday 2 weeks later.
What is the first and most important step when dealing with Health Plan Directory inquiries/PADC Cases?
Verify. Verify. VERIFY!
We must always verify what the issues are and ensure that it is appropriate to our network. Trust OUR directory and information over what is reported. There are "claims on what happens" and what actually happens.
Name 2 things that are great to utilize the "Not Ready" window for?
Recruitment emails
Aging requests
Roster Updates/Contract Loading
Call‑related requests
Special Projects
Team members should be aiming for at least a __% call acceptance rate in the phone queue.
90%!
We should aim for 100%, but understand that somethings things may happen. Keeping this number as high as possible ensure the best customer service to our callers.
High Priority Level requests such as Urgent Health Plan requests have what timeline for expected completion?
1-3 Business Days.
Keep in mind that "Due By" dates listed may alter, however we want to aim to pickup, complete and address anything "High Priority Level" immediately.
When paperwork is returned (Fax or Email), what is something the team member should Edit/Update?
Team members will “Edit” and update Request subject line.
This allows to easily identify paperwork and allow for linking/merging. Even if checking the faxes, if you determine it's not one of your requests, we still want to update to help each other out!
Any Non-FYI Health Plan requests should be treated with ____ _____ Priority?
High Level Priority.
Our Health Plans are our clients. That means we need to treat each of their issues with the highest urgency and priority. Quick and Attentive action keeps our relationships with our HPs strong and growing!
How may 2 Week Escalations does each team member get before needing to escalate a reqeust?
2!
This means each person has the ability to work a request up to 6 weeks to overcome obstacles and resolve issues before requiring escalation for review. This does not mean you have to wait 6 weeks if there is something we notice early on.
ALL Tracker Requests NOT originating from Incoming Calls will count as Substantive, with a few exceptions. Name 1.
PPG Changes without further Provider Communication/Outreach
Health Plan FYIs
Rate Sheet Requests – no follow ups/extra work
What is the important rule to remember when it comes to Request Priority Level in Tracker?
Do not modify Request priority levels in Tracker!
The Priority level grid within our training guide is to help you organize and prioritize your own work. The Tracker priority levels are a separate thing from this.
When picking up Requests, we always seek to work in order from oldest to newest, however we should also lookout for things that say _____ or ___ __.
Urgent or Due By.
While we do work the oldest first, some may come in with higher priority that we should be actively keeping an eye out for and looking to assing/work.
You find one of the PADC cases listed belongs to a National Group (MyEyeDr, Luxottica. Etc). Explain how to handle this process.
Send inquiry to the appropriate National Group Contact and let the Health Plan know that “Location is being educated on participation and should they elect to opt-out of participation, we will ensure our next monthly roster is updated accordingly”.
Our National Groups may require a follow-up or two, but they always get back to us on the update needed in relation to our inquiry. This allows us to easily send the "generic" reply above for that PADC case and expedite that process.
When making outreaches to providers offices, what's an important things to keep in mind when it comes to where they are located?
Time Zone!
Depending on where the practice is located, it can adjust the best and most appropriate time to call that provider/office. This is especially important when recruiting!
What total number of Overdue requests should we be aiming to keeps our own personal requests under?
10!
Remember to update your "due dates" accordingly as your 2 week escalation periods occur.
Provide a "Low Priority" Issue/Example, and the Timeline for completion?
Health plan FYIs that require only notation; simple directory/data corrections (Non-Claims Related); Rate Sheet Requests; Contract Requests - 5-10 Business Days
Remember! Although these are low priority and have a "longer" expected completion time, that does not mean they should take 10 business days to complete. This means they should be the "lower" priority depending on what other requests/projects you have.
You notice a duplicate ticket that is assigned to another associate. That request was assigned, or has not been updated in more than 2 weeks. When merging to the older ticket, what else should you do?
Tag Pras and Kevin along with original owner of request when merging/notating.
We want to be aware of these and get them on the radar for escalation if needed.
For Non-Urgent Recruitment Requests, what are the 4 steps?
1. Acknowledge with Health Plan
2. Send Standard Agreement in approved networks (Roadmap)
3. Inform HP we have sent agreement and will let them know if/when they will return.
4. Close out request
These do not require active follow up. The associate who sent will need to process if contract is returned, however these does not require keeping request open.
Due to new 2026 HR policy updates all hourly employees must take their __ minute lunch breaks by the ___ hour of their shift.
30 Minute. 5th Hour.
This means, if you clock in at 8:30 AM, your lunch should be taken by 1:30 PM at the latest. If you stay past 5, you will still follow the same rule from when you first clock in.
During incoming calls, we may have some items that fall outside "Substantive', but should still be tracked. Name 1.
First Call Resolutions (Am I PAR with Devoted?)
Basic Verification (What is the website for the Portal?)
No-Follow-Ups Required: Answer questions within 1-2 minutes on call
Incorrect Call Queue/Redirect – no actual team "work" done