Medium: the recipient is unable to reach a resolution with a health plan or provider regarding desired services/Dissatisfied with available plan/provider services.
High: describes dissatisfaction with a medical issue that may be detrimental to the recipient's health.
Low: recipient is unable to reach a health plan and/or provider to schedule an appointment/Dissatisfied with the available plan and/or PCP options.
Do not file a complaint and advise the member to go to the emergency room.
Inform the caller that we do not update special conditions and file a complaint in the complaint wizard.
Submit a task to a supervisor to inform them that you need approval to contact AHCA for the member.
Contact the SNU, explain the members situation and the request that the special condition be removed.
Select MC EX/SC in Health Track, click on the special condition box and submit the request.
Yes, because if the agent skips the question, it will result in a prohibited activity.
Yes, because all callers must state they have authority to make changes or obtain information for the person(s) they are calling for, even if they are calling for themselves.
Yes, because AHCA requires that all callers answer that question.
No, the agent may skip that question if they are calling for themselves.
The counselor can continue with the call because Sirena stated that she is emancipated.
The call cannot continue because Sirena is under 18 years of age and counselors are never allowed to speak to members who are under age 18.
The counselor should notify Sirena that legal documentation of her emancipation must be faxed in before she can speak for herself; she can continue the call on the newborn's behalf.
Sirena must contact DCF to have a note placed on her case stating that she is emancipated.
Tell Flora, she can't choose a plan and discontinue the call.
Advise Flora that Medicare is her primary insurance and she has limited Medicaid coverage that picks up some of the out of pocket expenses from Medicare.
Submit a discrepancy log to request for Flora to be enrolled into a plan.
Advise Flora that she can't pick a plan because she has FFS.
Allows qualified individuals to have Medicaid pay Medicare for Medicare Part B premiums.
Allows qualified individuals the option to enroll into Medicaid Managed Care Plans outside of their region.
Allows qualified individuals to have Medicaid pay for their Medicare premiums, deductibles, and coinsurance.
Allows qualified individuals the option to hire a family member to help provide services in the home.