Show:
Process Flows
EMMA Navigation
Stratification
Resource Check
Who Am I?
100
This process flow is used to determine a member's eligibility for an outreach attempt.
What is Core/TNA Prescreening Process
100
Where do you go to locate the Member's PCP information in EMMA?
What is Plans/PCP/Physicians Tab
100
What must a member have in order to trigger?
What is a disease on the hierarchy.
100
What type of EMMA queue is used for members that trigger BH?
What is SCM
100
"Hello my name is Amanda. I am calling on behalf of WellCare Health Plan a Medicare approved MA-only and MA-PD plan. May I please speak with Mr. Alberto Rosario?"
What is Universal Outbound Script
200
Once a member qualifies for a call, what is the process flow that you use to contact the member?
What is 3-Call Attempt Outreach Process.
200
What is the name of the program that the TNA department uses?
What is ME-Transitions Needs Assessment
200
Which of the following do not automatically trigger for Disease Management Level 3: BP Cuff, Wheelchair, or Weight Scale?
What is a Wheelchair
200
The way you would close your TNA program if the screening was started but it was not finished. (Member answered beyond question 10)
What is TNA Incomplete
200
I’m very sorry for your loss. Can you please provide the date of death? I’ll update our records. If you haven’t already, please notify the Department of Social Security. Thank you for taking the time to speak with me today. Goodbye.
What is id Deceased script.
300
Once we reach our third attempt and the member is still not reached, what process flow do we follow?
What is TNA - UTC Letter Request Process_Member not reached on 3rd attempt or no phone information available.
300
There are 2 places in EMMA to see if a member is currently Inpatient Hospital, Skilled Nursing Facility or Inpatient Rehab. What are they.
What is, Authorizations and Primary Concern/Living Arrangements/Legal
300
If a SMD member qualifies for Disease Management Level 3 what steps need to taken by the MER?
What is transfer to DM Nurse line 1-(877)-393-3090
300
For the 24 Hour Nurse Advice Line, which number would you provide Medicaid members with.
What is Medicare 1-800-581-9952
300
I appreciate your request, but we don’t have a “Do Not Contact” list for members. As your health plan, we must be able to stay in contact with you. In some cases, it’s even required. This is so we can keep you up to date on your plan benefits. We also give you information that might help you manage or improve your health. It’s all part of our commitment to you as a member of our plan. May I continue?
What is If “Do-Not-Call” Requested Script.
400
If the member is cased managed what is the process flow we follow?
What is Member Already Engaged in CM Outreach Process
400
What screening(s) does the TNA department use?
What is 2012 Transition Needs Assesment
400
If a Georgia Medicaid member states they have Asthma, and visited the ER 5 times due to asthma attacks. What would be their stratification level and queue assignments?
What is CM Level 4 and CCM Tele queue
400
If the member resides in the state of Florida and request to see an opthamologist, this is the resource that you must use in order to provide the member with the correct number.
What is Opthalmology POD Assignment List for PCP 7 8 15.
400
Thank you for calling . My name is , how are you today? Respond appropriately to caller’s response. May I please have the date of birth and complete address, including city and ZIP code to get started?
What is Universal Inbound script.
500
If we are doing inbound in TNA, what is the process flow we follow if the member recieved a UTC from the TNA department?
What is IB - Call due to TNA Message or UTC Letter
500
If a DSNP member is deemed UTC what is the name of the UTC letter in EMMA that would go to the Provider?
What is DSNP_Provider_ICP_UTC
500
If a member states they have Osteoporosis, 4 hospitalizations, and is taking 5 medications what stratification level would they be and which queue would they be placed in.
What is No stratification (they do not qualify).
500
What should your complete note and action code look like in Care Connect if you've successfully completed an Transition Needs Assessment.
What is CSCOWC, TNA - Outbound call to member, Member Reached ASantiago, MER Member Engagement Unit (866) 635 7045
500
, again my name is and / to welcome to , new health insurance plan. I’d like to give you some basic information about plan and ask a few health-related questions. It should only take a few minutes.
What is Plan Information Script.