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This SOP/CPG outlines the difference between Medical Records and Line Item Medical Records and includes a few examples of each. Medical Records are necessary for claims processing. Line Item Medical Records cannot be used for claims processing.
SOP/CPG: Medical Records (MR) vs Line Item Medical Records (LIMR)
This document is for all team members and should be reference for labeling and merging medical records.
CPG: Labeling & Merging Medical Records
This document details how to find and link an Account or Contact to a case, how to create a Contact if neither an Account nor Contact exists, and how to remove both an Account and Contact from a Case.
SOP: Populating Salesforce Account & Contact Name
This SOP contains annotations and descriptions of how various Help Cases are coded within Salesforce.
SOP: Case Coding
This explains how to read an SOP Document
REF: How To Read SOP Documents
This SOP will provide strategies to work through difficulties with pet parents as they arise.
SOP: Managing Difficult Interactions with Pet Parents
This document includes a non-comprehensive list of actual examination fees that should be excluded from coverage.
CPG: Covered vs. Non-Covered "Exam" Fees (Treatment as Exam Fee)
ADA & Disability Complaints and Requests: This SOP is for any Account Manager who encounters a Pet Parent complaint or request regarding ADA Compliance
SOP: ADA & Disability Complaints and Requests
This document is for any Customer Care Team members who are not a Licensed Producer in the Pet Parent's state.
SOP: Licensed Producer Redirect Process
This SOP is for any Customer Care Team members who interact with Pet Parents or Veterinary Clinics in reference to Direct Payments.
SOP: Direct Payments - CCT Responsibility With Key Messaging
This SOP/CPG is to be used when Account Managers receive a call or email for a claims-related issue that needs attention. We cannot escalate everything a PP asks for, but these scenarios are exception situations that can be expedited to a Claims Specialist for review.
SOP/CPG: Claims Escalation Process
This document contains all Salesforce Solutions pages with Standard Operating Procedure (SOP) documents sorted by applicable category. This does not include Claims Processing Guide (CPG) documents, however, it does contain any SOP/CPG hybrid documents.
REF: Salesforce - SOP List
This SOP is for account Managers and Customer Liaison Managers who encounter inquiries from Pet Parents who enrolled after 1/1/2022 and who are impacted by the option to provide Electronic Consent. Currently, this only applies to Pet Parents in the State of California, but this may be subject to change.
SOP: Electronic Consent Opt-in
This SOP is for all CCT members who receive a request from a Pet Parent to transfer/merge their pet(s) to/with another policy.
SOP: Pet Transfers (Transferring & Merging)
This SOP is for all Customer Care Team members who answer phone calls to Healthy Paws or make calls from Healthy Paws.
SOP: Call Management Processes
This SOP is for all Account Manager Customer Care Team members who interact with Pet Parents inquiring about Waiting for Info and Waiting for Review claims.
SOP: Missing Information Claims - For Account Managers
This SOP is for all Customer Care Team members who answer Pet Parent inquiries about Direct Deposit claim reimbursements. All Customer Care Team members who answer Pet Parent inquiries about how to set up Direct Deposits for future claim reimbursements.
SOP: Direct Deposit
This document outlines the different scopes for all Account Managers.
REF: Scope of Support for Account Managers
This SOP outlines the process for viewing documents attached to cases. This process varies between attachments and uploaded documents.
SOP: Viewing Case Documents - Attachments and Uploads
This SOP is for all CCT who encounter inquiries from Pet Parents regarding Open or Draft Invoice
SOP: Key Messaging for Treatment Plans, Estimate/Draft/Open Invoices, Payment Receipts, or Packing Slips
This SOP is for all Account Managers who receive a communication from a Pet Parent asking for multiple Explanation of Benefits (EOBs) be re-sent to them.
SOP: Resending Explanation of Benefits (EOBs)
This article is used for certain states which have exceptions
REF: State-Specific Exceptions
This SOP is for All Account Managers who receive a request from a Pet Parent to update their account information, change reimbursement percentage or annual deductible, or their pet's details.
SOP: Account Changes (Pet Parent Info, Pet Details, Pet Name, Address & Billing, Coinsurance & Deductible)
This SOP contains the processes for sending emails from Salesforce and handling written communications sent to Healthy Paws.
SOP: Written Communication Case Management
This SOP outlines how to handle coverage inquiries from our Pet Parents and Leads. It’s followed by both Licensed Producers when answering coverage questions from Leads, and Unlicensed/Licensed Customer Care Team Members when addressing coverage questions from enrolled Pet Parents.
SOP: Coverage Disclosure Key Messaging