Let Us Know Program
The Let Us Know (PDF) program is a partnership between Prestige Health Choice and the provider community, to collaborate in the engagement and management of our chronically ill members.
We have support teams and tools available to assist in the identification, outreach, and education of our members, as well as clinical resources for providers in their care management.
There are three ways to let us know about chronically ill members.
1. Contact our Rapid Response and Outreach Team.
The Rapid Response and Outreach Team addresses the urgent needs of our members and supports providers and their staff. The team consists of registered nurses and Care Connectors who are trained to assist members in investigating and overcoming the barriers to achieving their health care goals.
Call 1-855-371-8072, Monday through Friday, from 8 a.m. to 5 p.m., or fax a member intervention request form (PDF) to 1-855-236-9281.
2. Use the Availity Care Gap report.
When checking member eligibility, your office will receive pop-up alerts that indicate members who are at risk due to missing or overdue preventive services or underutilization or absence of disease-specific controller medication.
Run a care gap query report and contact the Rapid Response and Outreach Team to request outreach to a member.
3. Refer a patient to the Complex Case Management program.
Complex Case Management is a voluntary program focused on prevention, education, lifestyle choices, and adherence to treatment plans. It is designed to support your plan of care for patients with chronic diseases, such as asthma, diabetes, or coronary artery disease.
Members receive educational materials and, if identified as high risk, are assigned to a Care Manager for one-on-one education and follow-up. For more information, or to refer a patient to the Complex Case Management program, call 1-855-371-8072.