Annual Enrollment Period
What does ANOC stand for?
Annual Notice Of Change
*2 no's and a go*
Welltok Verification?
First and Last name only
Why did Humana change their name to Centerwell ?
- The pharmacy rebranding reflects how we continue to evolve to ensure mbrs have the best experience and reflects our commitment to putting the customers at the center of everything we do.
CWPCC Centerwell Rebranding FAQs
What does WISMO stand for?
Where is my order
When is open enrollment period ?
October 15 through December 7th
When faced with objection such as "no im good" what must we do to determine the root cause of the members no?
Ask probing questions
Inbound Verification?
ZIP
DOB
What is the definition of error code 516 mean?
516: Quantity Exceeds Number Of Packages Allowed
(Actions for RxNova Error Codes)
Name at least 5 tools you should be using actively daily?
- CCE
- CRM BLUE
- Argus
- RTM
- Avaya One X
- Nice
-Gold Crm
- Estart
When do plans become effective for those who enroll during annual enrollment period?
January 1st
Rebuttal for a member who has problems with their local mail man?
- Shipping to another family/friend
- PO Box
- Let mbr know we offer tracking on all items we ship so they can always be up to date on the status of their order
-Shop prior to medication running out so we give time to get through the mail
Two Part ?
Name
DOB
ZIP
What are some examples of reasons medications may not be eligible for the auto refill program?
- Controlled
-State specific controlled
- Discontinued or Deactivated
- Written for Less than 28 days
-Prescription for a minor (under 18)
(CPWCC Auto Refill Overview)
What must be verified before being able to use Surescript in RTM?
The complete address the mbr sees the doctor at
What can be done during open enrollment for members?
- Enroll
-Disenroll
-Return to Original Medicare
- Change their ma, mapd, or pdp plans
What would an effective rebuttal be to a mbr who loves getting out to their local pharmacy?
Example: Great mr/mrs mbr glad to hear u have a local pharmacy you love so u can get ur short term or emergency meds, what I can do for you is show you how to benefit with Centerwell pharm for long term maintenance meds
Refills?
- phone number associated with account
- street or house number
-zip
-medicare/humana ID
-DOB
During the coverage gap a member could pay how much for their medications?
25% coinsurance for brand name and generic drugs (specific amount depends on plan)
Coverage Gap Overview Medicare
What system do we need to ensure gets opened on every single call?
RTM - do NOT stop at rxconnect. Its only a glimpse of the mbrs account
What pricing tool would we use the most when enrolling future members who sign up during open enrollment period?
Rxcalculator
Argus (backup)
I need to speak with my doctor first
We can go ahead and send the fax request so the doctor has it when you speak with him/her (or when you have your appointment)
Third Party Authentication?
Poa/Consent if available. If not need verbal
Need to get the mbr to verify themselves.
Name dob zip (ib, 2 part)
name (welltok)
Name + Identifiers (refill)
Then get the mbr to say its ok to speak with 3rd party
What time do we work on Saturday October 15th?
Opening
What is a keycode for WELLTOK NO MEDS?
29312