Decision Desk

Decision Desk

Agents are required to call the Decision Desk when the Agent or Service Provider feels that the job should be denied.
DO NOT call the Decision Desk if there is a long hold for a specialist. This line needs to remain open for all recommended denials ONLY!

Authorizations

Phone Call

Before calling the Decision Desk, Authorizations Agents must:
  1. Take the full report including pricing
  2. Review all history
  3. Why this is a denial
    1. Supporting evidence to back up reason for failure/denial including pics if possible
  4. Review contract
    1. Pull the proper contract year to back the denial and have section and verbiage of denial
Upheld by Decision Desk:
  1. Authorizations Agent Actions:
    1. Must call out to the customer to advise of denial
    2. DO NOT call on CA/IA or Sam's Club HVAC unless it’s a Medical Emergency
  2. Decision Desk Actions:
    1. Update Sub-Status
    2. Update Claim, if needed
    3. Complete Job
    4. Complete and Close Service Order
    5. Create Autho-Job Follow Up Exception (Except CA/IA or Sam's Club HVAC)
    6. Notate using the Decision Desk Note Template
    7. Update tracker
    8. Send coaching as needed
Overturned by Decision Desk:
  1. Authorizations Agent will move the job forward or gather more information as directed by the Decision Desk.

Email

Before emailing the Decision Desk, Authorizations Agents must:
  1. Verify we have the full report
    1. If not enough information to make a decision, reach out to gather needed information (public w/email, escalations, or call out)
  2. Review all history
  3. Why this is a denial
    1. Supporting evidence to back up reason for failure/denial including pics
  4. Review contract
    1. Pull the proper contract year to back the denial and have section and verbiage of the denial
Decision Desk Action:
  1. Upheld:
    1. Update Sub-Status
    2. Update Claim, if needed
    3. Complete Job
    4. Complete and Close Service Order
    5. Create Autho-Job Follow Up Exception
      1. No exception needed for CA/IA or Sam's Club HVAC
      2. Email Sam's Club HVAC to Fran Callegari and Lindsey Frederick, White Glove will advise customer after reviewed
    6. Notate using the Decision Desk Note Template
    7. Update tracker
    8. Send coaching as needed
  2. Overturned:
    1. Reply to email advising agent to move forward with the job
    2. If Pending Information
      1. Create a public w/email, escalation and exception to gather needed information
    3. Update Sub-Status
    4. Notate using the Decision Desk Note Template
    5. Update tracker
    6. Send coaching as needed

Parts

Before emailing the Decision Desk, Parts Agents must:
  1. Verify we have the full report
    1. If not enough information to make a decision, reach out to gather needed information (public w/email, escalations, or call out)
  2. Review all history
  3. Why this is a denial
    1. Supporting evidence to back up reason for failure/denial including pics
  4. Review contract
    1. Pull the proper contract year to back the denial and have section and verbiage of the denial
Decision Desk Action:
  1. Upheld:
    1. Update Sub-Status
    2. Update Claim, if needed
    3. Complete Job
    4. Complete and Close Service Order
    5. Create Autho-Job Follow Up Exception
      1. No exception needed for CA/IA or Sam's Club HVAC
      2. Email Sam's Club HVAC to Fran Callegari and Lindsey Frederick, White Glove will advise customer after reviewed
    6. Notate using the Decision Desk Note Template
    7. Update tracker
    8. Send coaching as needed
  2. Overturned:
    1. Reply to email advising agent to move forward with the job
    2. If Pending Information
      1. Create a public w/email, escalation and exception to gather needed information
    3. Update Sub-Status
    4. Notate using the Decision Desk Note Template
    5. Update tracker
    6. Send coaching as needed

White Glove

White Glove Agent is calling to:
  1. Review or get clarification on the denial:
    1. Agent must make sure they have read the notes and have their concerns ready to relay to the Decision Desk
  2. Ask for a denial to be overturned:
    1. Agent must make sure they have fully reviewed the job/read the Decision Desk notes and have their concerns ready to relay to the Decision Desk
    2. Agent must have contractual reason to ask for overturn
      1. If an overturn is needed for a customer concession, agent will need to reach out to their supervisor
Decision Desk Action:
  1. Upheld:
    1. Advise agent the denial is being upheld and to advise customer
  2. Overturn:
    1. Advise agent of overturn and to move forward with the job
      1. If agent is unable to do so, Decision Desk will move it forward
    2. Agent will advise customer
    3. If Pending Information, agent will gather information
      1. If agent is unable to, Decision Desk will create public w/email, escalation, and exception to gather needed information
    4. Update Sub-Status
    5. Notate using the Decision Desk Note Template
    6. Update tracker
    7. Send coaching as needed


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