Placing a caller on hold/mute to tend to personal/non-work related activity.
What is call avoidance?
100
An expression of dissatisfaction with the manner in which the plan provides health care services regardless of whether any remedial action can be taken.
What is a Grievance?
200
EDSS
What is Enterprise Data Storage System?
200
Needs Referral to see specialist.
What is Gatekeepers plan?
200
Application, Member, Plan, Claim, Enrollment, Pharmacy, Billing, and General.
What are the 8 categories in MIIM?
200
Going 60 seconds or more without speaking to the caller.
What is call silence/dead air?
200
A general request or question about the plan, without an expression of dissatisfaction.
What is a inquiry?
300
ODM
What is Online Document Management?
300
All providers must be deemed prior to assisting members with this plan.
What is PFFS plan?
300
Give you full access with the ability to edit. This only available through select intents and request types in MIIM.
What is Launch account Summary?
300
Explain the need to place the caller on hold, ask them for permission, explain how long it will take, and express appreciation or acknowledgement for the hold.
What are the hold guidelines?
300
A decision about part c benefits or payments, or the discontinuation of health services that the member believes he or she is entitled to.
What is Organization Determination?
400
CTM
What is Complaint to Medicare or Compliance Tracking Module?
400
Treats diseases of the digestive organs including the stomach, bowels, liver, and gallbladder.
Who is Gastroenterologists?
400
Displays member demographic information, basic account information, and all available tabs.
What is the static header?
400
when a member threats to harm themselves or others.
What is one breath situation?
400
Allows the member's provider to remain engaged in all the aspects of the member's care and can only be initiated by a PCP.
What is a referral?
500
COR
What is Confidential Occurrence Report Form?
500
A fixed payment method that is based on the number of patients seen by the provider per month?
What is Capitated?
500
This tab lists any requests that the plan has received on the member's behalf.
What is the Notification tab?
500
Introducing yourself and the member before releasing the call.
What is warm transfer?
500
Managed by the reviewing entity and required for certain procedures.