HIPAA
How long is my HIPAA certification valid for?
1 year
How long do we have to work on escalates when we receive them?
2 hours
True or False?
RingCentral informs the member the call is going to be recorded.
FALSE
Is medicare part D eligible for enrollment?
NO
Where can I find the NDC and RX numbers?
Tredium, in the claim
How do I inform a member that I am verifying HIPAA?
In order to protect the privacy of your health information, I need to verify your identity by confirming 3 pieces of information.
What do we need to do in order to bypass an 8x?
Enroll
What piece of information do we need to repeat on a voicemail?
Callback number
What outcome do we use when we successfully enroll a patient?
CAP Approved
In what scenarios would I add to the tracker?
Enrolled → assign to OR (this includes new enrollment, auto renewal or if the member self-enrolled)
Not Qualified
Include a note with the reason:
State restrictions → assign to EH
Government-funded plan → assign to EH
Client 19136 – Minisink if current copay is less than PSP copay → assign to EH
Refused
ONLY if the client note explicitly states refusers can revert to plan (anytime we need revert to plan design, it must be assigned to EH)
Copay Card Fund Updates
Exhausted or Maximizer → assign to EH
Member Termed
Assign to OR – LH override team
Flagged as maximizer
Assign to EH to respond to EH team
What does HIPAA stand for?
HIPAA stands for the Health Insurance Portability and Accountability Act
What should we do if a patient says their copay card has ran out of funds?
Call the mfg
How do we warm transfer a call?
1. Put member on hold and ask first who's available via teams 2. Send information to the next caller via teams 3. Click "Ask first" and make sure caller is ready and recap purpose of call to the agent 4.Take member off of hold and introduce them to the agent and reassure them the agent will be taking over from this point forward. 5. End the call only for yourself
If a patient is already enrolled, what do we need to ask them or the pharmacy/manufacturer?
4 probing questions:
Where is the medication being filled?
When was the last fill?
When did enrollment occur?
Have you been using this card for multiple fills?
What other team has access to the ET?
Empirx
Can someone else verify HIPAA on another member's behalf?
Yes, as long as the other member gives verbal consent and/or they have an authorized PHI form per Tredium.
What should we do if a patient calls in saying they have a high copay at the pharmacy but we enrolled them last month?
Call the pharmacy and see if they are using the copay card and getting any rejection message
What are the 5 things that we need to say on every call?
1. We are on a recorded line
2. For HIPPA purposes, please verify 3 pieces of information
3. Do you have any secondary government funded insurances?
4.Do you have any questions?
5. Please feel free to give us a call back at 866-906-4854 if you have any questions or concerns.
What are the 6 pieces of processing information we need to notate on member notes after enrolling them for a CAP card?
Date of enrollment, BIN, PCN, GRP, ID and DRUG NAME
What are the two statuses we need to search by to find a patient?
All statuses and complete
What are the 5 most important pieces of information we need to verify a caller?
First name/last name, DOB, ZIP code, phone number, and insurance member ID.
Who do we call mfg's as and what is our caller ID on ring central?
Pharmacy and mfg outbound
What questions do we need to ask the pharmacy if they say the copay card is not working when we call it in?
1. Did you run this as a secondary to the primary insurance?
2.Did you run it for todays date?
What 5 things do we need to prequalify before enrolling a patient?
Client/Drug/program
Member termed (search alternate ID)
State restrictions
Associated tickets (2026 tickets)
If you have a copay card on file on IDIC, is it an autorenewal drug? Click the medication, its blue because its a link to the med info. IF its autorenewal, don't call, add note and add to tracker. If its not, enroll.
What responses on the ET are meant for us to answer?
Luna to respond, Luna call to pharm