Engagement Programs and Non-Routine Workflows
Where can we check Autism Team or Eating Disorder CM eligibility? (In CAMS and TC)
CAMS: Profile Header of Managed registration; (no PPO Low OPT or EAP Only)
TC: Product Feature/Summary; Autism/Eating Disorder listed
Member asking for their ID number. What do you do?
ID number is confirm only. You can direct the caller to the MyCigna website or mobile app to view their ID card electronically.
What is Inpathy? How do you get a member connected?
Inpathy is a vendor who works with telehealth providers for counseling and med mgmt in NY/NJ.
To connect a member, ask permission to share their info first! Then email inpathy with ID, name, DOB, phone, and email address for inpathy to outreach the member to assist finding an appointment.
Name one example of a discount a member may be eligible for through Healthy Rewards
Fitness: Gym memberships, wearable Garmin devices, virtual fitness programs
Alternative Medicine: Acupuncture, Chiropractor, Massage Therapy, PT, OT
Vision and Hearing: exams/glasses, lasik, hearing exams/aids
Meal Delivery
Yoga Products (mat, virtual workout subscription)
Caller is asking where their paycheck is?
Direct to HR (warm transfer if possible)
What is CoachRx and when would you refer a caller to CoachRx?
CoachRx is: Medication therapy support program to help medication adherence
Refer when: caller has questions about medication, has difficulty with medication adherence, mentions medication changes or medication cost concerns.
Cigna rep says they obtained verbal consent to release PHI to caller before warm transferring. Can you release PHI?
If warm transfer came from intake/Cigna Behavioral: yes, you can take their word
If from anyone else: No, you must obtain verbal consent from the member as well.
Can you search in PMRS for TalkSpace providers?
no, PMRS will not house TalkSpace referrals. Direct caller to talkspace.com/cigna to get connected with a counselor
Where would I find the incentives a member has available or see how much $ they have accumulated so far?
OneView: Motivate Me
or MyCigna
Caller states they are a manager at a company and there was a critical incident (death of an employee, robbery, homicide or suicide threat, industrial accidents, etc)
obtain the caller's name, job title, company, and phone number. Warm transfer to EAC team. If necessary, skype EAC team to find an available consultant.
Is play therapy a covered service?
YES! Play Therapy is a routine covered service, though we are unable to search specifically for those providers. Play Therapy is a routine part of therapy specifically for children.
What's the difference between TalkSpace and Happify or iPrevail?
TalkSpace is a platform for virtual ongoing therapy with a counselor. Happify and iPrevail are app-based programs that offer mental health resources and peer support (not counseling)
You are assisting a customer with locating their incentive information on their own. Where do you direct the caller?
mycigna.com -> wellness tab -> wellness incentives
mycigna mobile app -> incentives
Caller states their manager told them they have to call in and go to EAP counseling, but you see no notes in the case for a management referral. What do you do?
Open new case as self referral, send 5-10 referrals, do NOT generate auth, tell member to call back once appointment is set for auth. Do not give change of provider script. Tell employee to have their manager call in to start the process. Skype EAC team to let them know you had a caller for a management referral.
Caller looking for Suboxone referrals. How do you search in PMRS? And what if no referrals come up?
In PMRS: enter group index/dropdown; search by STATE; Relationship: "Medication Assisted Treatment Providers"
*if no results, search for reimbursement: psychiatrist with the speciatly "MAT: Buprenorphine/Suboxone"
*if no results STILL... direct member to http://www.samhsa.gov/medication-assisted-treatment/physician-program-data/treatment-physician-locator to locate provider in area. Have OON Provider call OCST.
HIPAA validate caller as normal, HIPAA validate 4 pieces of info from member in question, and obtain verbal consent to release PHI from member.
Caller wants to use MDLive for psychiatry and wondering what it will cost them. What do you quote?
Quote managed benefits as normal; INN OIF MH / INN OV MH
What is a "GateKeeper" incentive and what does it mean?
A GateKeeper incentive is a task the member will need to complete prior to being able to earn other incentives. Typically, they will be some kind of health assessment.;
ex: Personal Health Analysis or Biometric Screening.
GateKeeper Incentives will be indicated with a "GateKeeper" section on OneView -> Motivate Me
a member is very escalated, cursing at me, not validating HIPAA, etc.
Stay calm, ensure the member that you hear their frustration, if cursing and inappropriate language/conversation continues warn them and if they don't stop you can end call. Inform your supervisor of the situation
What does YHF stand for and what is one condition they can assist members with?
YHF = Your Health First
Covered conditions include: Heart Disease, congestive heart failure, depression, anxiety, bipolar disorder, low back pain, osteoarthritis, diabetes Type 1 & 2, asthma, etc.
If your call drops and you need to call your member back, what do you need to do at the beginning of the call?
Call recording disclaimer and fully HIPAA validate again (phone number you dialed can be used as a piece of verification)
Name one of the virtual programs offered by Cigna OTHER THAN Inpathy, TalkSpace, and app based programs (like Happify/iPrevail)
Meru Health, MAP Peer Recovery Support, NOCD
(see telehealth cheat sheet)
Name two ways you can locate incentive information for a member OTHER than OneView -> Motivate Me
- CCV
-OLAM
-myCigna
-NBA's (Guide Me Page)
Adult calling looking for learning disability testing/benefit info for self.
Inform learning disability testing is not a covered service, refer the member to the Pacer Center. For minors, refer to school district.