Authentication
1.04.37
What is the SOP for Caller Authentication - Inbound, SOP 1.04.37
2.1
Open The Call And Greet The Caller, SOP 2.1
2.16
what is Disconnected Caller, SOP 2.16
Solutions for when you don't know who to call.
what is the Contact and Transfer Quick Reference Guide Grid
2.3.1
SOP Clinical Inquiries and Access to a Pharmacist, SOP 2.3.1
When the caller cannot provide accurate or sufficient information to authenticate, you may speak to general information only such as:
General plan design
Scripting: This is (your name). May I help you?
What is the recommended greeting.
What is rule #1?
Always end a call by making the caller feel valued.
Hospital pharmacy, ER or staff calling for medical record or history
PCT
What do we ask on every call?
MOH
When all responses to the automated caller authentication questions match information in the system
What is IVRU authenticated
Scripting: I will be happy to provide you with my unique identification number which specifically identifies me. My identification number is <insert your RACF ID number>.
what is "provide your last name or RACF ID when requested.
Not Ready - 07 - Medical Breaks/Outbound.
What is the aux code you should be in, to make an outbound call.
Incorrect member on Card, Statement or Literature
RTL
Accuracy of a RX, medication list, healthcare provider's office request to stop a rx, tab ID
what is Call types transferred to PCT when open
A person who: is entitled by law to act on behalf of the patient in making decisions related to the patient's health care.
What is Personal Representative
Scripting: I apologize, I cannot hear you. Please call back for further assistance.
What is Silence on the Line/ account does not populate
When the RTL connects, explain the reason for the escalation and alert the RTL that the caller disconnected prior to the transfer.
What is an escalated transfer
Law Enforcement(FBI/Law Enforcement(FBI/Police) Police)
PC RPH
Allergy, medication event, not my medication, side effects, specific manufacturer or NDC product request.
what is Mandatory transfers for a counseling PC RPh
What do I do if a caller advises that they are going to record our call?
Advise the caller you do not wish to be recorded and respectfully ask the caller to cease recording.
Exception. This does not apply to business offices, that have automated call recording.
Will onnly request benefits and eligibility, and may:
Sound robotic
Answer questions in a way that doesn't make sense
What is AI EVA Robocall
Use Guide Me option, Disconnected caller returning a call, Issue requiring PC RPh to contact a PC RPh.
Explain the purpose of the call and reason for contacting the PC RPh
What is Disconnected from both the caller and the PC RPh
Escalated Order Status
WeCare
Brand/generic differences, damaged medication, defective medication, directions, duplicate therapy alert etc.
what is Calls requiring an offer of counseling by a PC RPh