maestro
what intent do you document for demographic changes?
Update member profile
Where can you find prescription copay level?
under summary tab, LIS co pay
Where can you see the start and end dates of their plan?
Under plan tab
Where can we go to view if there is a primary insurance listed?
In icue under member's detail tab.
What are 3 forms of information we need from the member to access their account in maestro?
Address
name
DOB
How do you properly close member's accounts in maestro
always select an intent and document and make sure the intent is closed. and select wrap up and complete any prompts on wrap up screen.
If a member is unaligned can we find their Medicaid id in maestro?
No if the member is unaligned the Medicaid id would be located in GPS.
What do you use the eligibility status intent for?
The eligibility intent is used for identifying if member's plan is still eligible for Medicaid benefits.
Where do we doccument in maestro if we have to do COB in macees?
Under mangae COB intent.
How can you tell if a member is ivr verified?
In your genysus it will populated under the phone call members three forms of info and it will say yes next to Authenticated.
Where do you not document in maestro?
In the wrap up screen under comments. All documentation should be done under an intent.
Where can you find the previous interactions on the member's account?
There is a recent interaction tab where is shows the exact documentation of the member's call and who the advocate was that took the call.
How can we send Authorized rep forms?
The form can be sent in macees or they can go to TennCare website and print one off and have it faxed or mailed.
Where do we complete a cob route?
In macees.
Can a Authorized Rep make purchases with U cards?
Yes as long as they are Hipaa verified and with member's verbal permission .
What intent do you use when member wants to enroll/ disenroll DSNP and medcaid member's ?
When a member want to enroll/disenroll you would use the enroll/disenroll intent in maestro for dsnp. For medicaid member would need to contact state and be provided with state contact.
Where can you find the current PCP?
Under summary tab it will show member's current pcp.
Can we view Medicaid pharmacy claims?
To view Medicaid pharmacy claims you as the advocate would need to contact optum regarding member's pharmacy claims
What does it mean when we are verifying insurance?
To verify insurance we need to look for verification date is over 30 days and the plan is termed and termed date.
What do select in maestro member's account if its not the member calling?
You would skip the member is contact box and go click on members account and press submit and verify the caller is an AR and fully Hipaa verify.
how do you properly handle nbas / knowing if they have NBAS?
Asking the member's permission if they have time to answer questions regarding their account and answering the appropriate prompts the NBA is giving you. To identify NBAS we would look for orange collum on the bottom left hand standing for NEXT BEST ACTION.
When can a member report their get moving challenge reward?
After the 10th of every month
What is the SODH intent for?
The SDOH is for Social Determine of Health to see what member is in need for under their plan or extra resources outside of their plan.
When documenting is maestro what do we need to include in the notes that we get from macees?
When COB was filed and the SF documentation number.
If a third party is calling , can a caller initiate a 3 way call for verbal permission from the member?
No we as advocates have to call the number on file for the member and Hipaa verify member and get verbal permission from member for caller to access the account.