Database Audits
What is the correct stage and PES Status for any disenrolled patient you connect with & notify that they are no longer on an accepted plan?
Stage = Closed Lost
PES Status = Winback AEP
During the initial chart review, when should we check the Y1 Patient Box?
If the patient is disenrolled & had their NPV within the last 12 months
What snippet is used to document an inactive task?
(.)petask
Now that all markets have been migrated into 1life, what should be added to every patient opportunity in SF?
1Life Link
When flipping a Disenrolled - New Payer patient to Closed Lost, what would the closed lost reason be?
Disenrolled New Payer
What should we update in the Senior Health Section in 1Life for a patient that is needing a PCP change with available form?
Additional Eligibility Details should be updated to reflect "Collect PCP Form in office and upload it"
What is the correct chart review outcome for a disenrolled patient that was last seen 18+ months ago?
Unengaged
You connect with a disenrolled patient and they notify you that they are no longer with OMS due to provider turnover. What is the correct stage and PES status for this patient?
Closed Lost & Winback Roy
When should we deactivate a 1life chart?
When it is confirmed a patient is no longer assigned & they don't have an upcoming appointment within the same month.
When is the Stage Change Date updated?
When flipping a patient to disenrolled same/new payer.
No, because there was no change of insurance - the stage stays the same.
What is the correct stage and PES Status fo rany disenrolled patient you are unable to contact after 8 attempts?
Stage = Closed Lost
PES Status = Winback - Unable to Contact
When should we update the close date when working a patient?
When we flip to closed lost
When we complete PCP change with a patient
When flipping to Disenrolled New Payer & they are Assigned in portal
When it is confirmed a patient is now CMS
During a chart review, a patient that has a Bad Member Status - Elected to go to new PCP, is Unengaged, and no longer assigned. What is the correct Chart Review Outcome for this patient?
Unengaged
When working an inactive task, the patient you're reviewing is in Aligned, are Never Engaged and active and assigned with the insurance on file. Should the stage be flipped to closed lost for this patient?
No, because the patient is active and assigned - the stage remains the same
When working disenrolled workbook, you come across a patient that has a bad member status of moved out of area. You confirm this patient is active with a new payer and is assigned to OMS. What would be the correct stage for this patient?
Disenrolled - New Payer
A patient calls in to complete PCP change & they are in closed lost / unable to contact with a stage change date in the previous month. You successfully complete PCP change with the patient. How should we update this SF opportunity?
As a Winback!! Flip stage to Disenrolled (stage change date should remain the same) update PCP change fields & put into Awaiting Roster Confirmation.
When a disenrolled patient is no longer active with a Medicare Advantage plan & are now CMS. What is the correct stage, chart review outcome, and PES Status?
Stage = Appointment Attended - PCP Change Completed
Chart Review Outcome = No further Action Needed
PES Status = Converted Confirmed
Close Date = Today
While working disenrolled workbook, you come across a patient in closed won that is no longer assigned and has a bad member status - Elected New PCP. Service Recovery connected with this patient 3 weeks ago and confirmed status. Is PES outreach needed? & how should we document this in SF?
No - Since service recovery recently connected, we close this patient out and send to Winback Roy.
Stage = Closed Lost
Chart Review Outcome - Service Recovery outreach complete
PES Status = Winback Roy
Stage change date = Today's date
During initial chart review, what chart review outcomes need PES outreach?
PCP Update Needed - Seen/Not Seen this Year
Bad Member Status Elected New PCP - Unless service recovery or Engagement has connected within the last 30 days.
Bad Member Status Moved Out of Area - Unless it is confirmed the patient is no longer within OMS market.
Not on an Accepted Plan
Unengaged