Verbal DOR Workflow

Front

What is the age requirement for an authorized representative in a verbal DOR?

Back

The authorized representative must be 18 and older.

Front

What must be obtained from the member during HIPAA verification?

Back

First and Last Names, Member ID number, Date of Birth, Address.

Front

What must you do even if the member was verified at the beginning of the call?

Back

Re-verify the member once you have started the Verbal DOR process.

Front

What should you ask the member regarding filing a Grievance or Appeal?

Back

Ask if they are allowing their Informal Representative to file a Grievance or Appeal on their behalf.

Front

What information must be obtained about the authorized representative?

Back

The name (correct spelling) and the relationship to the member.

Front

What section of the DOR form should be reviewed and discussed with the member?

Back

Section ‘C’ of the DOR form.

Front

What options should be confirmed with the member regarding information sharing?

Back

All information or limited information.

Front

What must be disclosed to a member regarding verbal DORs?

Back

The caller’s right to act as an Authorized Representative, the validity of the verbal authorization, and the member's rights.

Front

How long is a verbal authorization valid for?

Back

Only for the life/level of one appeal/grievance.

Front

What should member services offer regarding DOR forms?

Back

Offer to send a written DOR as they are valid for up to one year and can be used on multiple grievances and appeals.