🔐 HIPAA Hot Seat
If you’re unsure whether an identifier is correct, what should you do?
What is ask for another identifier?
A caller seems suspicious and is asking questions about claims or benefits. Which task type should be used?
What is Claims Assistance?
This NBA helps members complete a short health survey that identifies health risks and supports Devoted's 5-Star performance.
What is the Health Risk Assessment (HRA)?
This appointment is designed for members with an open health gap, a new diagnosis, or who already had a D2Me earlier in the year.
What is a D2Me Check-In?
This is the primary reason Devoted recommends a D2Me visit even if a member already sees their PCP regularly.
What is an extra layer of support and care coordination?
When can you review or update incorrect information on file?
What is after HIPAA verification is complete?
What is the simplest test for determining whether HIPAA verification is required?
What is whether you need to access the member's record to provide the information?
Members have this many days from their plan start date to transition active care to an in-network provider.
What is 90 days?
1. A standard D2Me Initial appointment usually lasts this long.
2. A D2Me Initial or Annual appointment may be extended to this length when a translator is needed.
1. What is 40 minutes?
2. What is 60 minutes?
This is what guides should offer members who are uncomfortable with technology.
What is walking them through the technology or helping them connect?
For Devoted to discuss member information with a broker, the broker must hold this status.
What is the Agent of Record?
A broker not listed as Agent of Record wants PHI. What must occur first?
What is member HIPAA verification and verbal authorization?
A member calls with an open NBA. T1 discusses the NBA and then uptiers the call to T2, who also addresses the NBA. How is credit assessed?
What is each Guide is assessed separately based on the NBA opportunity available during their call segment and what action they took? 🚩🏆
What are the different types of D2me appointments
What are:
D2Me Initial-This appt type is a member's very first visit with the D2me team
D2Me Annual -yearly check-in for members who had a D2Me Initial within the past year.
D2Me Check-In - members with an open health gap, a new diagnosis, or who already had a D2Me earlier in the year
Super Star Visit? - This visit targets members with STARs gaps who have not recently had a D2Me appointment.
If a member only has a flip phone, Devoted may provide this for the visit.
What is an iPad to borrow?
A caller discusses a member's account but HIPAA verification cannot be completed. What information should still be documented?
What are the caller's identity, relationship to the member, and general information discussed?
A new person joins an already verified call. What must be documented?
What are their name, relationship, and the member's permission to speak with them?
1.When unable to bring the member into the conversation and the PHI cannot complete the remaining steps, guides should do this.
What is close the NBA as unable to complete?
What are the top two priorities for improving acceptance?
1. Correctly state D2Me is a video visit
2. Tie the visit’s value to the member’s situation / address objections
If a member says the visit is a waste of time, guides should describe it as this
What is a small investment in future health?
A Guide calls a member, states the member's full first and last name before verification, accepts an identifier provided by a family member, and discusses claim information before completing HIPAA. Name three compliance concerns.
What are:
Once the member comes on the line in a facility, what must happen before discussing account information?
What is complete HIPAA verification?
Members who complete a D2Me visit often describe the biggest benefit as having this when they need care after hours or when their PCP isn't available.
What is a trusted support system/safety net? 🏆🚩
A member discusses anxiety, transportation challenges, or chronic pain. What coaching opportunity exists?
A member calls about prescription costs. During the conversation, they mention arthritis and difficulty getting around. After resolving the issue, the Guide says, "You qualify for a D2Me visit. It's 40 minutes." The member declines.
Identify three missed opportunities.
What are: