Call Resources
Workflows
EPA Errors
Procedures
MISC.
100
What is the phone search feature?
A search feature built into HubExpress to search alternate phone numbers for the prescriber, pharmacy or plan
100
Call Fail HCP/Plan/Pharmacy:
We must make two attempts total. If after two attempts the call still fails we need to snooze for an hour for a final attempt. (This includes disconnected or the timer isn't moving.) If there's an actual recording stating the number is disconnected, we can trust that.
TRUE OR FALSE
FALSE
We must make three attempts total, if after three attempts the call still fails we need to snooze for an hour for a final attempt.
100
What's the hashtag we use when working Puerto Rico EPA errors?
There is no hashtag for Puerto Rico/PR keys, as we do NOT chat these into the Slack room and will mark these for help.
100
Escalated User after hours, what do we do?
Apologize to the party that no one is available to take their call at this time. Take down their name, number and key (if applicable) and let the party know that a member of leadership will be calling back within 24 hours.
Send the name, phone number and key (if applicable) in the #ps-sp-lateshift room and the on-call leader will ensure a callback is made within 24 hours.
Note: When dealing with a frustrated caller, you should always show courtesy and always be empathetic to the caller's concerns or frustrations. Even if they are not providing that same courtesy back to you, you should always be providing a white glove service.
100
What is the slack format when asking for assistance?
Hubble Link:
Question:
Hashtag:
Possible answer:
Resources used:
200
What phone numbers are available for click to call?
NONE. Do not use the click to call feature within Hubble. All numbers should be copy and pasted or manually entered into Five9
200
Initial unsnooze, HCP accessed PA, called HCP, no answer verbal message voicemail... WHAT IS NEXT?
2 day snooze mark next step as 2nd call to HCP
200
Give me three common EPA error examples...
PA not needed/Available Without Authorization
Patient not found, Patient Inactive, Member not found, cannot find matching patient, cannot be processed electronically, etc.
Responses indicating that the plan has cancelled/closed the request
Invalid data was entered
The fax is "greyed out"
200
What layout is used when reporting a PAE/PQC in hubble?
Category
Response
Name
Enter the Name of the person that is reporting the PAE/PQC
Phone Number
Enter the phone number of the person reporting the PAE/PQC
Group
Select Prescriber, Plan, or Pharmacy depending on who reported the PAE/PQC
Duration
Enter duration of call in hours, minutes, and seconds
Call Outcome
Select Prescriber, Plan, or Pharmacy – Other, depending on who reported the PAE/PQC
Notes
Enter notes, include any of the details associated with the PAE or PQC, confirm that the Microsoft From was submitted
200
Who on our team has a child named Oliver?
MICHELLE!
300
What is the difference in the "New Request" button & "Enter Key" button on the Covermymeds Portal?
New Request should be used when a provider wishes to create a brand new Prior Authorization.
Enter Key should be used to access an already existing prior authorization that is not yet in the user’s account.**
300
How is the BMS Workflow different from the General Workflow?
We DON’T follow up with the pharmacy at any point for test claims.
We CAN call the pharmacy to verify insurance information
We CAN make HCP courtesy calls in some instances.
300
You will know there is an ePA error if the touches show a.....
"N/A Outcome."
300
How do we record a Northera Tracking note?
#NortheraFeedback
Copy this ^^^
Add this hasthtag every time you hear user sentiment - positive or negative
ALL Appeals & PA’s please
300
How many Mckesson paid holidays in 2023 fall on a Monday?
5
400
All BMS drugs are excluded from grouping.
TRUE OR FALSE
FALSE
No AMP Lite Drugs are excluded from grouping.
Medications to EXCLUDE from grouping:
Biogen medications (Tecfidera, Tysabri, Avonex and Plegridy)
Nuedexta
Epidiolex (only for pharmacy calls)
Mayzent
400
What are the differences between requests created by pharmacy and prescriber?
Created by Pharmacy
If a pharmacy has started a PA, the key should have all information included: patient’s name and date of birth, prescriber name and phone, and plan information. If any of this information is not available, please do NOT chat into the help room for alternate numbers.
Created by Prescriber
If there is no pharmacy listed on the key, there is no pharmacy information available.
400
You recieve this EPA error on an Aetna PA
Case cannot be processed electronically. Your request has been received and will be reviewed manually. You will receive a decision via fax within 72 hours.
How do we proceed?
Treat this plan response as a confirmed submission.
Snooze 5 days from plan response for a final plan call.
If the plan indicates no request on file, make 1 courtesy call to the prescriber and offer hard copy fax/plan phone number.
400
How many steps in the Natural Disaster Workflow?
Five
400
What gender is Kianna's baby & when is her baby due?
Boy 5/25
500
What do we do when you receive a call from a user who expresses dislike for Covermymeds?
Empathize with the user and try to assist with the request. If the user continues with negativity, let them know we can leave note stating not to reach out to their office for follow up. Try to handle objections to the best of your ability and feel free to reach out to a leader if you need additional assistance for an escalated call.
500
Resubmissions are created for which drugs on AMP Lite?
Please note: Resubmissions are currently only created for Ayvakit, Northera, Norditropin, Odomzo, Spravato and Yonsa in AMP Lite.
500
You recieve this EPA error on an Envolve PA...
001 Bad XML Index and length must refer to a location within the string. Parameter name: length
How do we proceed?
f Prescriber is DNC, do not complete ePA error workflow. Snooze request 2 weeks for a final Pharmacy II NC Call (or Plan call if pharmacy is DNC). 1) Click "Edit Request" and check the fields in the PA to make sure they are the appropriate length. Fields to double check – phone number is 10 digits, zip code is 5 digits, NPI is 10 digits.
2) Give the prescriber a call to let them know if any of the fields are missing/have an added number and assist user with completing PA. If all fields are correct: Offer hard copy/plan number to complete request.
500
What is Navitus Health Solutions PCN?
NVT
500
Who and when was CMM founded?
CoverMyMeds was founded in 2008 by pharmacist Sam Rajan and developer Matt Scantland