Escape room huddle

Escape room huddle

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Why are you here?

You have entered a dark and unknown world from which you have to get out before it's too late and you will be locked in forever. Answer the questions correctly to get the final password.

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Mission 1

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Locked

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What should you open on every call that will give you general benefit information?

The member is calling about high cost of medication and after doing your research you find that the member is in the coverage gap. What is required to offer to the member?

If the member gives you background information that is important to the grievance, should you include that information in your grievance notes?

When can you submit a coverage determination for a 2025 plan?

Mission 2

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Completed

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If a member calls about the high cost of their medication and you offer a tier exception, the member declines, do you check yes to the coverage determination question in compass?

When should a test claim be ran?

If you forget to run a test claim and you have to file a grievance, can you check yes and have your grievance pass?

After Clicking Capture Activity button, the Call Summarization Notes from Cresta tool should be pasted in the Activity Logs Notes box but there is missing information. Can you make edits or add the details to the capture activity box?

Mission 3

Completed

Completed

Locked

Member is calling about Albuterol Sulfate 2.5 mg/3 mL (0.083 %) solution and a grievance is needed. Do you file as a one day or a standard?

To make sure that we have up to date information on the member's account and we want to raise our survey count, what should you ask for on every call?

For best practices, what should you verify is correct at the beginning of a call in case the call is disconnected?

When can you cold transfer a call?

Remember the code

216

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You are filing a grievance because the automated system did not understand the member's ID number.

Do you choose yes or no is the grievance resolved?

Completed

Completed

Completed

Mission 4

Along with asking the resolution question at the end of the call or before a transfer, what else should you do?

When filing a quality-of-care grievance you would choose yes, no further CCA action required?

Not all calls regarding coverage determination require a grievance to be filed?

14+3

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