How do you look up a member with the last name Lu?
Last Name: Lu__*
100
What should the Call Type be set to?
Call Type: Doctor Call
100
Where do you put PHI?
In the PHI Shedder Bin!!!!
100
If an MDO is call in Specialty Medication Only. What will you do?
Verify Drug and transfer to Specialty Department
100
What are the Shipping Options and Prices?
Best Method: $0
2nd Day: $17
Next Day: $23
200
What do you look for to make sure you pulled up the right account?
If the ID begins with a G or R, DOB, Address, Eligible, previous Rx History, and Middle Name.
200
What should the Call Type be set to?
Call Type: Participant Call
200
Do we need to re-verify the member or MDO after being transfered from Customer Care?
Yes
200
MDO is calling a specialty and regular Rx. What do you do?
Verify drug and process FastStart like normal. Inform RPh upon transfer.
200
If the Member does not have a payment method on file and wants to add a credit card. What would you do?
Maintain Payment Options then add credit card in PeopleSafe.
300
Why would we look in Client Program Offerings and Virtual Pharmacy?
Client Program Offerings: Auto Refill and Auto Renewal
Virtual Pharmacy: ROCC Address for Hardcopy of Rx
300
What tabs will you fill out in a doctor call?
Cardholder and Prescriber Tab
300
What are three HIPAA identifiers?
Full name, DOB, address.
Member ID, Rx #, Phone #
300
What information do you need from the MDO on a controlled medication?
They provide: Doctor full name, address, NPI#, and DEA#.
We verify: Phone # and Fax #
300
If we can not verify the MDO fax # what should you do?
Save to PBR Queue after filling out the FastStart Fax Request
400
Where can you find the Caremark Messaging Platform?
PeopleSafe - Change Contact Info
400
What tabs will you fill out in a member call?
Cardholder, Prescriber, Add Rx, Allergies/Health Conditions, and Order Summary Tabs.
400
Who can't call in a Rx for the Member?
Care W/O Member
Prior Auth Rep W/O Member
Senior Team W/O Member
Other Groups/Teams not on the handout
400
If the MDO provides a different address from what we have on file and the member does not answer. What will you do?
Process FastStart like normal.
Leave address as "None"
Order Comments: Address Verification Required
MDO Provided "Address MDO gave"
Inform RPh upon transfer
400
If a member says they want to put a hold on their medication. What is your next step?
Stop See Comment: "Today's Date, Please hold (medication name) until (date)"
Expiration date: 2 weeks out
500
What tab would you use to offer Auto Refill/ Auto Renewal?
Order Placement Tab
500
On a member call will you have a reference or confirmation code at the end of your call?
No
500
When you need to do an address verification on a dr call what three HIPAA identifiers do you need to continue with the call?
Full Name, DOB
Member ID# or Rx# or Phone # of member
500
If we have a different fax number on file. What do you need to do?
Maintain Prescriber in FastStart
Rec Status: DS Approved
Edit Fax # and change Status: DS Approved
Save and Close
Search again to refresh the page
500
What do you do when a member does not have a history of the Rx they are requesting?
Probe the member.
Leave a regular PeopleSafe Comment:
“(Enter new drug/strength/dosage form) provided by the Member is inconsistent with the Member history (this is the first fill).”