Referral Life Cycle Communication Quiz

The statement is explaining that before processing or staffing a referral or sending a manual authorization request to the Adjuster/Case Manager for products/services, one needs to verify carrier rules and UR guidelines per ICON. This means that it is necessary to check the rules and guidelines set by the carrier and UR (Utilization Review) before taking any further action. Therefore, the answer "True" indicates that this statement is correct.

When a product or service is not available, it is best to escalate the issue to your manager internally. Your manager is responsible for overseeing your work and can provide guidance on how to handle the situation. They may have the authority to make decisions or escalate the issue further to higher levels of management. By involving your manager, you ensure that the problem is addressed and resolved in a timely and appropriate manner.

To confirm the availability of the requested products/services for the injured worker and to establish the Delivery/Start of Care time frame, you would need to communicate with the vendor. Vendors are the ones responsible for providing the products/services and can confirm their availability and coordinate the delivery or start of care. Attorneys may be involved in legal matters, hospitals primarily focus on medical treatment, and the UR (Utilization Review) department typically reviews and authorizes medical services, but the vendor is the most appropriate contact for confirming the provision and timing of the requested products/services.

You contact the Physician and/or Discharge Planner for all of the above reasons. This includes confirming orders, obtaining prescriptions when necessary, and confirming delivery specifics if items are for discharge.

If you come across any barriers or issues during the referral life cycle, you should contact the Adjuster/Case Manager immediately. This is because the Adjuster/Case Manager is responsible for managing and overseeing the referral process, including addressing any obstacles or problems that may arise. They have the knowledge and authority to resolve issues and ensure a smooth referral process.

All of the above options are correct because communication plays a crucial role in the life cycle of a referral. By answering questions before they're asked, it ensures that customers have all the necessary information and reduces any confusion or doubts they may have. Providing a better customer experience is achieved by maintaining regular communication, keeping customers informed, and addressing their concerns promptly. Additionally, proactive communication can help dissolve complaints before they even arise, as it allows for open dialogue and quick resolution of any issues.

To verify delivery demographics required to process a request, you would contact the Injured Worker. The injured worker is the person who has been injured and is receiving medical treatment or compensation as a result. They would have the necessary information regarding their location and other details needed for processing the request.

The correct answer is 1 business day because it is important to contact the injured worker and the vendor as soon as possible to ensure a smooth delivery or start of care. Waiting any longer than 1 business day may result in delays or complications in the process.

The correct answer is "Every 24 hours or 1 business day." This means that the follow-up on Vendor and Product load requests is done either on a daily basis or within one business day. This ensures that there is regular communication and progress tracking for these requests, allowing for timely updates and resolution of any issues that may arise.

In home health ongoing communication, calls are made to the injured worker for stable long-term care files every 30 days. This frequency ensures regular check-ins and updates on the injured worker's progress and care. It allows for monitoring their condition and making any necessary adjustments to the care plan. Making calls on a monthly basis strikes a balance between staying connected with the injured worker and giving them enough time to adjust and stabilize in their care routine.

When dealing with complex services and contacting the Adjuster/Case manager for authorization or to address any barriers or issues, it is important to always carbon copy the Sales Representative. This is because the Sales Representative is responsible for managing the sales process and maintaining a good relationship with the client. By carbon copying the Sales Representative, they can stay informed about any communication or challenges that may arise with the Adjuster/Case manager and provide necessary support or follow-up actions if needed. Carbon copying the Manager may not be necessary in this scenario as the Sales Representative is the primary point of contact for the client.

The correct answer is "Every 2 business days". This means that for all vendor directed referrals, the communication with the vendor will occur every two business days until an ETA or purchase order is issued. This ensures regular and timely updates between the company and the vendor, allowing for efficient coordination and progress tracking.