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Working towards a healthier you
InterSPN Mid Year
Working towards a healthier you
INTRODUCTION
Learning Outcome
By the end of this InterSPN session you as a GEMS trainee to be able to address all customers,
within your own environment, on the roles and functions of each service provider within the
GEMS network, while demonstrating the GEMS values of excellence, collaboration, integrity,
member value and innovation.
3
Topic overview
SPN overview – Who each SPN is?
Scope of service – What each SPN does?
Rationale for service – Why each SPN does what they do?
Out-of-scope of service – What each SPN does not do?
SPN interface – Which SPN collaborates with whom?
Contact details for referrals
Escalation information
Top four (4) FAQ’s of each SPN
Five (5) assessment questions for each SPN
Observed top knowledge and service delivery gaps of each SPN
4
Learning outcomes
By the end of this session the trainee will be able to:
Give a brief overview of all SPN’s
Describe and list the scope of services, according to each SLA, for all SPN’s
Explain the rationale behind the services each SPN is required to provide
List the out-of-scope services
Provide name of the SPN responsible for the identified out-of-scope service
Illustrate, with the use of an example, which collaborative SPN interfaces exist
List a set of contact details for referrals for each SPN
Explain the escalation process and provide a list of contact persons
Provide a list of the top four (4) frequently asked questions in each SPN environment
Provide a set of assessment questions for all SPN’s presentations
Provide a list of the knowledge and service delivery gaps for all SPN’s.
5
SECTIONS COVERED IN THIS TRAINING
6
MODULE 1
Contributions and Debt (Medscheme)
Appliance Management (MCO) Amended
Ambulatory PMB (MCO)
Case Management & Oncology (MCO)
HBM Pre-Auth (MCO)
ADRM and CNBR (MCO)
MODULE 2
Marketing (ASI)
MODULE 3
Claims (MH)
Customer Service (MH)
Ex-gratia (MH)
Correspondence
MODULE 4
PBM (Medikredit)
Total Medicine Management (Universal)
Chronic Courier Company (Medipost)
MODULE 5
EMS (Europ Assistance)
Optometry (Opticlear)
Maternity and HWSS (Healthi Choices)
Dental (DENIS)
HIV (THRM)
7

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Inter spn mid year introduction

  • 1. Working towards a healthier you InterSPN Mid Year
  • 2. Working towards a healthier you INTRODUCTION
  • 3. Learning Outcome By the end of this InterSPN session you as a GEMS trainee to be able to address all customers, within your own environment, on the roles and functions of each service provider within the GEMS network, while demonstrating the GEMS values of excellence, collaboration, integrity, member value and innovation. 3
  • 4. Topic overview SPN overview – Who each SPN is? Scope of service – What each SPN does? Rationale for service – Why each SPN does what they do? Out-of-scope of service – What each SPN does not do? SPN interface – Which SPN collaborates with whom? Contact details for referrals Escalation information Top four (4) FAQ’s of each SPN Five (5) assessment questions for each SPN Observed top knowledge and service delivery gaps of each SPN 4
  • 5. Learning outcomes By the end of this session the trainee will be able to: Give a brief overview of all SPN’s Describe and list the scope of services, according to each SLA, for all SPN’s Explain the rationale behind the services each SPN is required to provide List the out-of-scope services Provide name of the SPN responsible for the identified out-of-scope service Illustrate, with the use of an example, which collaborative SPN interfaces exist List a set of contact details for referrals for each SPN Explain the escalation process and provide a list of contact persons Provide a list of the top four (4) frequently asked questions in each SPN environment Provide a set of assessment questions for all SPN’s presentations Provide a list of the knowledge and service delivery gaps for all SPN’s. 5
  • 6. SECTIONS COVERED IN THIS TRAINING 6 MODULE 1 Contributions and Debt (Medscheme) Appliance Management (MCO) Amended Ambulatory PMB (MCO) Case Management & Oncology (MCO) HBM Pre-Auth (MCO) ADRM and CNBR (MCO) MODULE 2 Marketing (ASI) MODULE 3 Claims (MH) Customer Service (MH) Ex-gratia (MH) Correspondence MODULE 4 PBM (Medikredit) Total Medicine Management (Universal) Chronic Courier Company (Medipost) MODULE 5 EMS (Europ Assistance) Optometry (Opticlear) Maternity and HWSS (Healthi Choices) Dental (DENIS) HIV (THRM)
  • 7. 7

Editor's Notes

  1. Insert company brand / CI to reinforce “Name”.. Use .png image if possible. Delete the GEMS logo example in this slide and replace
  2. Insert company brand / CI to reinforce “Name”.. Use .png image if possible. Delete the GEMS logo example in this slide and replace