Hours: 6:00am - 5:30pm Pacific Time
Shasta delivers exceptional Customer Service. All inbound phone calls are answered by a live Customer Service Specialist, not an automated voice system. Our in-house Specialists effectively handle all incoming calls with consistent accuracy and respect. Representatives are knowledgeable on all client plans and go the extra mile to meet each callers’ needs, adhering to our “Golden Rule” motto of treating others the way they would like to be treated in the same situation. The majority of calls are answered within 60 seconds, with an abandon rate below 5%, and a first-call resolution at 99%. Follow-up and keeping promises is a priority. Internal auditors conduct random weekly phone audits for all Customer Service Specialists to ensure clients are receiving high quality service.
- Finding network providers that meet patient’s specific needs.
- Making medical appointments on behalf of the patient.
- Transferring the patients medical records to a new provider.
- Setting up single case agreements for specialized non-PPO providers.
- Determining out-of-pocket expenses for multiple providers. Patients can submit EOB’s, statements, etc. to Shasta and we will assist with explaining and verifying out-of-pocket expenses.
- Calculating how much is owed when there are other coverages.
Shasta's Customer Service Team
- Submits appeals on behalf of the patient after obtaining all necessary chart notes or reports.
- Secures the necessary documentation from providers for claim review.
- Verifies eligibility and benefits based on plan limitations.
- Initiates pre-authorizations.
- Alerts the medical management team of candidates for case management.
- Reviews reasonability of charges.
- Prescription overrides and pre-authorization.
- Finding alternative generic or preferred medications.
- Finding community resources outside of a plan such as resources assisting with travel, meal delivery, custodial care and other payment options.
- Obtain charges and out-of-pocket estimates prior to a procedure being performed.
- Obtaining a Medical Doctor’s Prescription (MDRX) as well as ordering durable medical equipment and scheduling delivery.
Shasta's Member Assistance Advocate (MAA) Program
Working in benefit plan administration, we see the struggles of sickness, financial burden, stress and emotional trauma that many of your members deal with. In our effort to help, Shasta’s Member Assistance Advocate (MAA) program offers a more hands on approach to assist members with some of the direct or indirect healthcare issues they experience. Some examples of these services are:
- Finding community resources to assist with bringing meals, building wheel chair ramps, bill payment assistance, etc.
- Assistance in scheduling follow-up appointments.
- Helping comb through the multitude of paper received when there is more than one payer to determine what, if any, patient responsibility is owed.
Online Self Service Portals
24 hours a day/7 days a week
Self-service options enabling members to monitor their personal information.