Cost Share
First PB needed when agent states the J code is only covered through PBM.
What is "I am not calling for prescription benefits. I am calling for medical benefit coverage?"
We process the call this way when an operator forgets to PB against incorrect or ambiguous information.
What is Operator error/Unanswered questions/incorrect answers?
We must add this task note when the agent states they need to transfer you to a different department.
What is "Plan administered by separate department; contact: XXXXXXXXXXX.?"
We must call this number for Wellmed when it is the medical group for a patient.
What is 8772997213 option 3?
This rapper is known as "Slim Shady"
Who is Eminem?
In Xolair, plans we fill in the copay amount for.
What is GEHA & Florida Blue?
We process the call this way for a BCBS call when we have called the Blue Line and agent will not proceed due to patient's address being incorrect.
What is Invalid Task/Incorrect input information?
We must use this task note when the patient's coordination of benefits has not been updated in over 3 months.
What is "COB has not been updated recently. Please advise patient to call insurance company?"
We input this in the platform if the agent states the PA was cancelled even after proper PB.
What is not on file? ( Never headset this field)
This singer's 1989 album includes "Blank Space" and "Shake it Off"
Who is Taylor Swift?
We input this when the agent states the patient is only responsible for one copay per visit and the copay amounts are the same.
What is " No" and "In a single visit only the specialist office copay applies?"
We process the call this way when the agent states they can not provide benefits and the provider must use the portal.
What is payer issues/benefits only available online?
In Xolair, we must add this a task note when the provider is in a different state than the insurance. (BCBS CALL)
What is "The local BCBS Specialty Pharmacy will be determined upon approval?"
In Xolair, we input this in the platform when an agent says there is a PA form available but the agent can not provide step by step how to locate the form.
What is not available?
"Is this the real life? Is this just fantasy?" opens this Queen song.
What is Bohemian Rhapsody?
PBs needed when agent states that copays apply to a seperate copayment maximum.
What are "What is the amount?" and "And how much has been met?"
This is the number of times that we can have payer not reachable before you can fail the call.
What is 4? Must have called the Blue Line if it is a BCBS call.
We must include this task note when the agent states that PA is required for the J code and PreD is required/highly recommended for admin code.
What is "Predetermination required/highly recommended for XXXX code. Contact XXXX Department at XXXXXXXXXX?"
We would access this tab in the SOP if agent provides a non-standard name for an associated PBM/SP.
What is the PBM vs SP tab?
This Russian composer created Swan Lake.
Who is Tchaikovsky?
In Xolair, the process we take when the agent does not understand the "Does the copay apply regardless... question.
What is If GEHA or FL Blue we will input agent's response after PB. If any other plan, if the J code and SOV have same copay amount we can enter yes. If the J code and SOV have different copays and if the agent cannot answer, we would escalate like normal?"
We will process the call like this when the agent provides a number where benefits can be collected and will not transfer the call.
"What is change phone number?
We must add this TN when the agent or IVR can not locate the patient.
What is none. IVR/Representative could not look up patient based on ID, name and date of birth is automated which means DO NOT add it manually at all.
In Xolair, we must collect this information when the agent provides a SP and it is not on the Xolair list and it is mandated.
What is phone number, fax number and mailing address?
This artist broke streaming records with the album Sour.
Who is Olivia Rodrigo?