Systems
Enrollment
Pharmacy
Time Frames
Codes
100

We document in here on every call

What is MC400

100

When is open enrollment?

  What is October 15th through December 7th

100

CVS is a ___________ pharmacy

What is standard?

100

How long is a standard grievance?

What is 30 days?

100

We use this code to change a persons address?

What is END012?

200

We look in here to see if the member has a PRD or POA

What is MC400 >> Memo Alerts

200

where do we do verbal plan changes at?

What is the sharepoint?

200

We use ________ for our mail order scripts

 What is Express scripts

200

how long is a standard cdag?

 What is 72 hours?

200

We use this to send out a PRD form

 What is HPA021

300

We see a members SNF days in here  

What is healthplanet?

300

if a member wanted to switch plans in the middle of the year they would need a

What is a SEP?

300

what two systems do we need up for do a CDAG?

What is ESD and PA hub?

300

how long is a standard odag?

What is 14 days?

300

This code is a good cause to use when we quote someone's deductible

What is BNA250?

400
We go here to see a denial reason for members medication (The claim was ran through the pharmacy)

What is ESD?

400

what is the plan code to change a plan?

What is ENE090?

400

How many calls do we give the member to let them know that their medication was either denied or approved

What is 1

400

how long is a expedited ODAG?

What is 72 hours?

400

We use this code to document a travel benefit inquiry

What is TRV?

500

How do we enter a members ID number in ACI?

What is drop the 01 at the end add a 0 at the beginning

500

When a member attests to an LEP what three things should we be asking them?

What is 1. the dates in question, 2. what coverage they had. 3. do they have their old ID number with their old policy?

500

If we see a denial in pa hub for a medication what is the next step we do for the member?

What is check Medhok for an appeal, if there is none offer the appeal for the member

500

How long does a good cause reinstatement take?

 what is 7-10 days

500

What is the code we use to discuss silver sneakers?

What is BNA 189?

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