FTE Escalation Queue

Scenarios 3, 5, 6 and 7 routed to staff. Assign or resolve entries as they're worked.

Monthly reporting period: 1 Jul 2026 – 31 Jul 2026 (UTC)

Which call outcomes land here

Calls end in one of seven dispositions. Four of them can't be finished by the caller and create a queue entry for staff; the other three (no answer, wants info, appointment scheduled) are handled on the call itself.

MemberCare gapTypeStateScenarioBarrierCreatedActions
M100662#90336BARRIER-CATEGORIZE
resolved
DeclinedScenario 6: Member refuses the service on this call. Escalated so staff can record a barrier code — the reason mix feeds the B4 decline-barrier breakdown.TRANSPORT27 Jul 2026
M100727#90371DEMOGRAPHIC-UPDATE
assigned
Wrong contactScenario 7: Number belongs to someone else, is disconnected, or the member has moved. Escalated for a demographic update so future outreach isn't wasted; the gap is not counted as a reached attempt.26 Jul 2026
M100701#90357SCHEDULING
open
Scheduling assistanceScenario 5: Member is willing but needs help booking — provider choice, transport, interpreter, or hours. Escalated to staff to arrange the appointment with the member and provider.26 Jul 2026
M100610#90308BARRIER-CATEGORIZE
resolved
DeclinedScenario 6: Member refuses the service on this call. Escalated so staff can record a barrier code — the reason mix feeds the B4 decline-barrier breakdown.DISTRUST22 Jul 2026
M100480#90238VERIFY
assigned
Already completedScenario 3: Member self-reports the service was already done, but no claim or supplemental record confirms it. Escalated for verification against claims/EMR. The gap only closes once the record is confirmed — self-reported values are flagged in KPI B-series.18 Jul 2026
M100441#90217SCHEDULING
assigned
Scheduling assistanceScenario 5: Member is willing but needs help booking — provider choice, transport, interpreter, or hours. Escalated to staff to arrange the appointment with the member and provider.16 Jul 2026
M100922#90476BARRIER-CATEGORIZE
open
DeclinedScenario 6: Member refuses the service on this call. Escalated so staff can record a barrier code — the reason mix feeds the B4 decline-barrier breakdown.DISTRUST13 Jul 2026
M100597#90301SCHEDULING
assigned
Scheduling assistanceScenario 5: Member is willing but needs help booking — provider choice, transport, interpreter, or hours. Escalated to staff to arrange the appointment with the member and provider.12 Jul 2026
M100805#90413SCHEDULING
open
Appointment scheduledScenario 4: Member booked, or already holds, an appointment that closes the gap. Gap moves to in progress and is re-checked after the appointment date.12 Jul 2026
M100753#90385SCHEDULING
assigned
Scheduling assistanceScenario 5: Member is willing but needs help booking — provider choice, transport, interpreter, or hours. Escalated to staff to arrange the appointment with the member and provider.11 Jul 2026
M100467#90231DEMOGRAPHIC-UPDATE
assigned
Wrong contactScenario 7: Number belongs to someone else, is disconnected, or the member has moved. Escalated for a demographic update so future outreach isn't wasted; the gap is not counted as a reached attempt.10 Jul 2026
M100857#90441SCHEDULING
resolved
Appointment scheduledScenario 4: Member booked, or already holds, an appointment that closes the gap. Gap moves to in progress and is re-checked after the appointment date.9 Jul 2026
M100740#90378VERIFY
open
Already completedScenario 3: Member self-reports the service was already done, but no claim or supplemental record confirms it. Escalated for verification against claims/EMR. The gap only closes once the record is confirmed — self-reported values are flagged in KPI B-series.7 Jul 2026
M100831#90427DEMOGRAPHIC-UPDATE
assigned
Wrong contactScenario 7: Number belongs to someone else, is disconnected, or the member has moved. Escalated for a demographic update so future outreach isn't wasted; the gap is not counted as a reached attempt.6 Jul 2026
M100896#90462VERIFY
assigned
Already completedScenario 3: Member self-reports the service was already done, but no claim or supplemental record confirms it. Escalated for verification against claims/EMR. The gap only closes once the record is confirmed — self-reported values are flagged in KPI B-series.4 Jul 2026

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