Missing Information
How are missing information attempts different from peer to peer attempts and where can you located those attempts?
Missing information attempts are automatically sent out by the portal. Those attempts can be located in the portal.
What version of the peer to peer scheduling assistance tool should you be using currently?
Version 8
You must educate the provider about the benefits of the portal AND offer assistance with sign up
What tool should you always use to document a call?
Salesforce Logging Tool
A new submissions pends to "Review by Humana". What should the provider?
Do not tell the provider that its pending "Review by Humana" at this time. Inform the provider that clinical information will be needed to process this request and provide our fax number/ email.
How many missing information attempts are sent out before the request is moved forward in the process?
three attempts
What boxes are required to be checked off when scheduling a peer to peer?
just the "P2P scheduling box". (Peer to Peer Request box is no longer required)
When checking if the cpt code requires authorization, you should trust the portal and attempt to submit a new auth. True or False?
True. The PAL is a great resource, but the portal can provide more information is regards to rather a cpt doesn't require authorization or if it requires authorization from a different company.
If the salesforce logging tool does not provide an option/statement that matches the interaction of the call. How should you document the call?
Continue to use the logging tool to choose the best option that matches the interaction. After pasting the completed statement into salesforce, edit the statement to match what occurred during the interaction.
How do you check the status of a request that is pending "Review by Humana"?
Check CGX first to get the status of the request and clarification of Missing Information if needed. If you do not have access to CGX, reach out to your room support. Do not send them over to Humana if you can locate the information in CGX.
If the provider states that they can not provide the missing information, what can you offer?
You can offer a peer to peer or the option to withdraw the request.
You must always ask for a secondary number. True or False
True. You must always ask for an extension as well
When will Oscar providers no longer be able to submit authorization through the portal?
February 1, 2024
What should you do if you can not attach the documentation to the service request?
Include the tracking ID number in the documentation and state that the service request in not populating in Salesforce.
What should you do if a provider want to scheduled a peer to peer for a request that is pending "Review by Humana"?
The call must be transferred. Slack the template provided in the Wis in the serviceops-intake Slack channel and tag the @intake-leads and @intake-supervisors. You must obtain permission from the Intake leadership using the Slack template prior to making the call.
A provider states that she/he has already provided the missing information and ask for it to be reviewed again. What should you do?
Document the information for the nurse team by adding a new contact in the portal and move the request to RN review.
Where do you attach the screenshot of the booking confirmation?
In the file section of a service request in salesforce
What is required in the call closing?
Recap the call, confirm the user has no more remaining issues and brand Cohere Health.
What is the best way to document portal education when a peer to peer was scheduled during an inbound call?
You may document that you "were unable to portal educate the call". Portal education and adoption is not required if the call is solely to schedule a peer to peer.
How do you calculate the DDB of a pended "Review by Humana" request?
By using the TAT Wis, add the timeframe related to your request by the date of submission.
If a provider request to speak to a nurse, when is it okay to transfer the provider to a clinical reviewer in FCR?
Request is DOS today or within 24 business hours or the provider indicates this is an emergent request.
What template should you use when scheduling a peer to peer for a TX commercial cardio case? Where do you sent that information to?
Template: @ P2P Team: Cohere ID-XXXXXXXX Commercial TX Cardio P2P scheduled with Dr XXXXX - please review
Post a Slack in #serviceops-p2p-dnw-only and tag P2P team using below template ONLY if p2p scheduled was a commercial TX Cardio case.
What scripting is required after obtaining the providers and facility information during every new submission?
Expedited Scripting: Will applying the standard timeframe seriously jeopardize the life, health, safety of the member or others due to the member's psychological state, or subject the member to adverse health consequences?
Calls Inbound - Humana is when a humana rep calls cohere or transfers a provider over to cohere.
Calls Inbound- Non Humana is when there was no interaction with a humana rep.
Caller wants to know why their request was voided and whats to know why. Where can you find that information in CGX?
Check CGX (or you may need to reach out to someone who has CGX access). There may be a delay in integration.
Check the progress tab on the left hand side of CGX.