TO CHASE OR NOT TO CHASE
Cases should not be assigned to Chase if the member is using pill pack service OR this specific delivery pharmacy
What is: Carelonrx
A member requests a 90 day supply, but only 30 day supply remain at the pharmacy. The initial associate should not do this.
What is fill 30 day supply?
You spoke with the pharmacy about the refill, you asked the pharmacy associate to send a refill request to the provider for more refills. Where do you notate that information?
What is: On the chase notes section and on your questionnaire.
You see a yellow sticky note that indicates the provider will only accept refill requests from member, what should you do while you're still on the phone with member.
What is ask the member if they would like you to conference in the provider office so the member can request refill? Or ask the member if they can contact the provider to request the refill
The initial associate isn't required to contact this party to verify patient/provider relationship (Chase will determine if a call is needed, and complete if necessary)
Who is the provider?
These future fills should not be assigned to Chase.
What is 90 day supply future fills?
If member wants to begin using Carelonrx for future fills, what should you ask the member in order to prevent a gap in medication fills. (keeping in mind a new AHD referral process can take a week to 10 days to 2 weeks)
What is, would you like me to get 1 last fill at your local pharmacy so you don't run out of your medication.?
Before reassigning a case to Chase, review previous Chase assessments and these notes to avoid duplicate outreach. (Hint: They show at the top in HIP)
What are Public View Yellow Sticky Notes?
Before assigning a case with a new provider, ask whether the member has completed this.
What is the first appointment /established care with the new provider?
To avoid delays in processing when a member requests a refill from a non-original prescriber, you must ask the member if they have taken these 2 steps with that new provider
What is "have you established care with the new provider and spoken to them about this medication?"
This would be your assignment rule for a case that only has a non-target medication that needs a refill
What is : Do not assign to chase
If the member tells you they have an appointment with the provider scheduled for a specific date, where should you document that information.
What is on the notes to chase section and/or on your questionnaire?
If the member doesn't hear from the pharmacy about their medication within 3 days, you should instruct them to do this.
What is contact their pharmacy and/or provider's office to get a status on the prescription?
Because there are only 7 calendar days to obtain a paid claim, when a member picks up a 30-day supply of target medication and agrees to 90 day supply going forward, you must follow this assignment rule.
What is: Do not assign to chase.
Before asking Member's new pharmacy to transfer a prescription from the old pharmacy, the initial associate should do this first to confirm active refills remain
What is review members prescription history/prescription information tab in COS/M360?
If the pharmacy indicates they will refill medication on a specific date, where should this information be documented for the Chase team
What is in the "notes to chase" field on the chase submission form?
To prevent duplicate outreach when a provider's phone number is for a hospital or urgent care, this is the question you should ask the member, about their PCP
What is: Have you spoken with your PCP about this medication?
If the prescription is out of refills, you'll want to ask the pharmacy associate to do this to the provider to avoid delays.
What is send a refill request to provider?