Insulin Calculations
How many pens come in one box of the Novolog Flexpen?
5 pens
Can we use ZD to search for any customer information (PHI)?
No
*week 21 - May 26th email
What macro do you use if you need to make changes on an in-progress shipment? (It has not hit export to robot yet)
Reupload
What would you do if you got this copay rejection "Host Processing Error"?
Resubmit this claim
How would we direct the agent to proceed with rejection codes 88 and 569?
A- send the 569 rejection email to the customer
b- advise the customer to reach out to their insurance
C- advise doing an IST macro to see if the code 88 can be overridden to remove the 569 rejection
Answer- C
How many vials of the Lantus do you need for 3000 units?
3 Vials
When CC agents get inbound or outbound calls about STBO & LTBO tickets do they have required talking points, they need to address?
Yes
*week 20 - May 21st email
What macro do you use when the shipment was sent to the wrong address? What do you need to check before submitting this ticket?
Reroute/Redeliver
If it is Mail Innovations or SurePost
What does this copay rejection mean "Days Supply Exceeds Plan Limitation"? (3 possible answers)
Refill too soon or Prior authorization required or Day supply is limited by the insurance plan
What should the agent do when they see this rejection?
Step Therapy, Alternate Drug Therapy Required Prior to Use Of Submitted Product Service ID
A- Request a F/U PA macro to be submitted
B- Offer GRX
C- advise the insurance does not cover this medication
Answer- A
How many pens of the Lantus Solostar will I need for a 30-day supply, if I use 70 units a day?
7 pens
70 x 30=2,100 units needed for a 30 days supply. Each pen is 300 units, 2,100 / 300 = 7 (7 pens)
When would we use the 'NEWP Requested Start Date' Macro
Definition of NEWP Requested start date macro: If a NEWP requests a start date that is future dated for 3 or more business days.
*Week 15 - April 14th email
What macro do you use if the shipment was deleted due to the insurance being terminated, we added the new insurance, and the start date has not passed?
Reupload
Does this copay rejection require a PA "Product Not On Formulary"?
Yes
Can coupons be used with Good Rx or just by themselves and not using insurance as a base?
No on Good Rx and coupons have to be used in tandem with insurance.
If I apply the Diclofenac 3% 100-gram gel 3 times a day how long will this tube last?
33 rounding down or 34 rounding up (rounding down is best) days
100 grams / 3= 33.333
What macro would we use for bulk only issues customers report. Example: if they say they did not receive it with the PP.
Camera Check Macro
*Week 17- April 28th email
What macro do you use if a new prescription has a future start date and the customer needs a shipment of this medication right away of this medication?
Trick question, you would just submit a F/S if the customer needs it before the upcoming shipment
What does this copay rejection mean "Product/Service Not Appropriate For This Location"?
Prescription must be filled at a specialty pharmacy
How would you troubleshoot or advise the agent to troubleshoot this rejection?
*DAW Code Value Not Supported
A- suggest to just use DAW 1 to run the copay
B- suggest looking at the Rx and see if the MD listed a specific DAW code and to make sure the medication name in the copay checker matches the RX
C- tell the customer it's not covered
Answer B
If I use 72 units a day of Humulin R (vial) what are the total units needed for a 30-day supply and how many vials for that supply?
2,160 units for 30 days
2 vials= 2000 units
72x30=2,160
Should you submit a "QA Eval" macro if the issue happened on a chat and/or email?
No, these types of issues should be handled by the agent working on the complaint.
*Week 15- April 14th email
What macro would you use if the account is a NEWP and the PT requests a transfer in?
NEWP medication changes
What does this copay rejection mean "Date Written Is After Date Filled"?
Claim is submitted before the prescription is effective
What does this rejection code mean and do we know how to advise the agent to proceed?
Discrepancy Between Other Coverage Code And Other Coverage Information On File
A- Claim has been submitted to a primary that has been set up as secondary insurance or
B- Claim has been submitted to a coupon without a primary plan selected
C- Both A&B
Answer C