Communicating Benefit Information

Case manager identifies that member has

a benefit question

Case manager refers to the policy to

determine if it is a basic benefit

Is the benefit
identified as a basic
benefit?

Case manager will provide a warm

transfer to a member services
No
Yes representative to assist with benefit
explanation.

Locate the benefit and scripted language

in the database

State the benefit information to member

using scripted language

Case Manager assesses member

understanding of benefit

Case manager will provide a warm

Does member
transfer to a member services
understanding No
representative to assist with benefit
benefit?
explanation.

Yes

Case manager continues to address other

reasons for call
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