IRO Policy
Waiting for SPD
Waiting for Trust
Waiting for Pt sign
Waiting Election form
100
Who do you CC into your email to the pharmacists around a policy?
Who is BLM TEAM, created via your outlook
100
If there is an SPD in the client folder from the last 6 months or current year, what should you do?
send the SPD along with the case to the IRO
100
What should you do with TRUST client and there is an email in the client folder verifying TRUST from 3/3/2018?

proceed with sending the case to the IRO

100
what is sent to the patient when we are in need of the patient signature?
the case not forwarded letter and the external appeal filing form
100
where can you possibly locate the signed election form if not in the client folder?

Houston, under Carrier/Set up form” tab /DIV Implementation and anything mentioning APPEALs/attachments

200
What is step 1 of the Policy Process for IROs?

what is Always Read and follow the word doc on Tips for pulling the OCEP Policies before proceeding

200
what should you do on Day 1 with an urgent/standard clinical case?
Email the AM for the SPD, send the case to the IRO.
200
What should you do on Day 2 of a case waiting for WITH TRUST?

On Day 2, If the IRO is URGENT, Email the AM for a 2nd attempt and notate the email with your 2nd attempt, copy in Jen - send the case to the IRO . Indicate on the form that it is WITH TRUST - Save the email in the M drive. Jen will save a copy on her end for billing purposes when the IRO comes around to collect payment

200
what is sent to the Dr, when we need the patient signature?
the case not forwarded letter, faxed.. and the external appeal filing form
200
If you cant locate a form in Houston, what should you do?

Make the first attempt to email the AM.

300
Do you have to email the pharmacists on every policy?
No, only if you are not comfortable with what you found OR there is not a previous email to reference
300
What should you always do with any SPD you receive?
Save it in the client folder.
300
what should you do on Day 3 of a WITH TRUST IRO that is standard?

On Day 3 (Standard requests only), Email the AM for a 3rd and final attempt and Copy in Jen. - Send the case to the IRO. - Indicate on the form that it is WITH TRUST. - Save the email in the M drive. Jen will save a copy on her end for billing purposes when the IRO comes around to collect payment.

300
what should you do with the case not forwarded letters after sending?
upload them into C360
300
what should you do on Day 2 of waiting for signed election form

On Day 2, Email the AM for a 2nd attempt and notate the email with your 2nd attempt

400
In your email to the pharmacists, what 3 things should you include?
member details, Product, IRO policy you think you should send
400
What should you do on Day 2 with an Urgent or Standard Admin IRO?

On Day 2, Email the AM for a 2nd attempt and notate the email with your 2nd attempt

400
what should you do with a WITH TRUST IRO on Day 3 that is Urgent?
Trick question, that case should have already been sent to the IRO
400
what communication should be added into C360?

Add a case communication into C360, that a copy of the letter was mailed to the member and faxed to the Dr for patient signature.

400
what should you do on Day 3 of waiting for signed election form?

On Day 3, Email the AM for a 3rd and final attempt, send mildly threatening notice that client will need to decision the IRO if signed form is not received . - Place the IRO email in the folder with notation of 3rd attempt. If AM replies with confirmation for client to process, send the appeal to them. Document the case in C360. File the IRO in the M drive

500
What should you do with the email response from the pharmacist?
Save the email in the policy folder, attach the original policy you sent and label the subject line with the drug name
500
What should you do on Day 3 with an Urgent/standard Admin IRO?

On Day 3, Email the AM for a 3rd and final attempt, send mildly threatening notice that client will need to decision the IRO if SPD is not received . Place the IRO email in the folder with notation of 3rd attempt. If AM replies with confirmation for client to process, send the appeal to them. Document the case in C360. File the IRO in the M drive

500
What if you have sent the WITH TRUST case to the IRO and the AM emails you back the Trust while the case is still at the IRO?
Trick question, email the IRO the Trust info
500
what should be your final step after processing a request that doesn't have a patient signature?
File the case in the M drive
500
what should you do with a case/email IRO that is waiting on an election form that has not been received despite attempts?

Save the Case in WAITING until one of the above happens

 (form sent or located)
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