NEW Exempt Grievance (ODG) Assessment

Exempt Grievance (ODG) apply to which group?

• Member identified under CA Company Code 200C and 360 members.

• Member identified under CA Company Code 200C.

• All California groups.

In what ODG category will poor documentation fall?

• G1/G2

• G8

• G4

• G10

Under which tab in Member Composite Screen can you verify whether or not a member is designated as a 200C member?

• Member

• Policy

• Group

When do you complete Exempt Grievance (ODG) task that automatically generated?

• At the end of the call before you wrap up.

• Before you complete any dependency task.

• Whenever the task appears.

A member calls back about a previous interaction. What would you select for the dissatisfaction reason t o capture the dissatisfaction?

• IVR Issue

• Claim

• Issue with Service(previously prior inquiry)

When you transfer the call to UM/BH department. This is considered?

• Exempt Grievance (ODG)

• Expedited Grievance

• Standard Grievance

Which letter should we send if additional information is needed for authorization?

• S-978 ODG Prior Auth Missing Info

• S-927 ODG Missing Claim or Need More Info

• S-926 ODG Contact Covered CA

• S-928 ODG Prior Auth Missing Info

For which type of grievance is a written and verbal response to the member on the outcome required within 72 hours?

• Exempt Grievance (ODG)

• Expedited Grievance

• Standard Grievance

If you receive a Exempt Grievance (ODG) on a Wednesday, when does the ODG timeline expire in accordance with our contract with the CA DMHC?

• Wednesday night.

• End of the next business day.

• Friday Morning.

Which of the following is considered a Exempt Grievance (ODG)?

• • Member has a complaint regarding the cleanliness of the provider’s office.

• • Member calls because they did not receive their ID card. The associate was able to send the member an ID to resolve their concerns.

• • Member is upset that their prior authorization was denied.