Genesys
What is the preferred method of transferring a call and should be used unless the transfer isn't tied to a specific policy?
The Call Transfer button
What are the hours of operation and phone number for the GLP-1 call center?
Hours of Operation: Mon - Fri, 8 a.m. - 7 p.m. ET
Phone Number: 855-273-0102
What is the Medicare GLP-1 Bridge BIN and PCN?
BIN: 028918
PCN: MEDDGLP1BR
Do we send authorization requests?
No, this is automatically sent when 1st claim denies
A beneficiary wants claim status but cannot find their MBI. What should you do?
Provide general information and give self-serve options for finding the MBI.
How do you transfer a call by entering a specific number?
Click the Phone Book tab in CRM
What Medicare Part D plan types are eligible for GLP-1 Bridge?
Employer / union group waiver plans (EGWPs)
Medicare Advantage (MA) that offers prescription drug coverage MAPD plans
Limited Income Newly Eligible Transition (LI NET)
Special Needs Plans (SNPs)
What is the name of the system where you view claims?
DomaniRX
Where do you check for authorization status?
PAHub
After authentication, you find a denied claim in DomaniRx. What should you use to determine the next action?
GLP-1 Bridge DomaniRX Actions for Error Codes
Once a caller is connected to the correct department, what do you click?
ClickClick the Complete button on the Transfer pop-up window
What is the prescriber eligibility for GLP-1?
Can write prescriptions for beneficiaries without enrolling in Medicare.
Respond to prior authorization requests once a claim is on file.
Can't be on the Preclusion List for the drug to be covered under the Medicare GLP-1 Bridge.
Who is the primary payer for GLP-1 medications, and do they coordinate benefits with any other insurance?
Medicare GLP-1 Bridge is the primary payer and does not coordinate
Where do you click to look for decision letter in PAHub?
Once you click the hyperlink and expand the EOC, you select Notifications.
What is the next step for a claim not found in DomaniRC?
Explain that a claim may not have been submitted to the Bridge yet and advise that the pharmacy can submit the claim.
How do you make a blind transfer?
Ensure that the call is authenticated. Access the Plan tab on the Person Account page. Click the Call Transfer button corresponding to the type of plan/area you're transferring the call to. Search for the appropriate Call Reason name from the list. Click the radio button next to the department you're transferring to. Click the Blind Transfer button in the Phone Book.
What medications and formulations are covered by the GLP-1 Bridge?
Foundayo- Tablet
Wegovy- Injectable and Tablet
Zepbound- Injectable, commonly referred to as KwikPen.
How many days supply can a member get for GLP-!?
Prescriptions won't be filled for more than a 30-day supply.
By using the CoverMyMeds platform or by sending a fax.
If you receive a call from a pharmacist, should create an interaction and case in CRM?
No
What do you click to initiate an outbound call?
New Interaction
What authorization requires are there for GLP-1 Bridge?
Body Mass Index (BMI) greater than or equal to:
35 at the time of starting GLP-1 therapy
30 at the time of starting GLP-1 therapy with a diagnosis of more or more of the following:
Chronic kidney disease
Heart failure
Uncontrolled hypertension
27 at the time of starting therapy with a diagnosis of:
Pre-diabetes
Previous heart attack
Previous stroke
What reasons can a pharmacy claim have errors at point of sale?
Beneficiary not eligible
Exceeds quantity limits
Prior authorization required
Refill too soon
How long does the authorization take to process?
It can take 72 hours for prior authorization decision.
What is the standard greeting for GLP-1 calls?
"Thank you for calling the Medicare GLP-1 Bridge. My name is [advocates name], your healthcare advocate. How may I help you?"