DOD
This tool is used to price medications in the event that ESD is not providing pricing information. Ex: This might occur during a system outage.
The Tricare Formulary Search Tool
What is the privacy statement for MEDD calls?
At Express Scripts, we take your privacy very seriously. That is why we always ask you to provide some personal information to ensure we are speaking with the correct person.
I did want to let you know that you are not required to provide any health-related information to me and that the information provided will in no way affect your membership in the plan.
*Must state to remain complaint.
New PTO/PST for the entire year is administered on what day of each year?
The 1st of January. As a reminder, you have to prioritize making what you have for the year last and make wise decisions about how you use your time to ensure coverage for the entire year.
*Reminder* - Check your PTO/PST Balances
Patients must choose where to fill their long-term Rx (home delivery or retail).
Special Instructions: Educate the member on the following; retail courtesy fill allowance, pharmacy options Express Scripts and/or retail pharmacy, and place a decision on file (HAP or manual).
Select Home Delivery - Active Choice (SHD-AC)
I have the following resources available to me if I need help on a call:
SME/Evening Chat, Team Lead, Supervisor, Team Chat, KIM, Call Notes, Smart Tab...
What contributes to your daily adherence %?
Length breaks, lengthy lunch breaks, going to things on your schedule too early or too late, missing something on your schedule, starting work late, ending work early, not submitting aux templates, personal time usage.
Patients have the option to fill 3-month supplies of their long-term prescriptions at home delivery or at a specified retail pharmacy (For Cigna members at a specified Cigna 90 Now retail pharmacy.) **Not all pharmacies are in the 3-month network. Patients are not required to use home delivery, but will see a cost-savings if they choose to do so.
Special Instructions: Patients are NOT required to fill 90 day supplies. Educate the member on the In-network pharmacy (view Pharmacy Lookup).
Voluntary Smart 90
True of False. Prescribers are to be confirmed for renewals prior to processing renewals.
True. This is not necessary for refills, but this is required for renewals to avoid a QSO.
Agents are scored to proper hold and transfer techniques. How are you expected to handle holds and transfers?
Agent is required to utilize proper techniques for holds and/or transfers when assisting a member. Proper techniques include: Provided a reason for the hold/transfer. Acknowledged the caller and confirmed the same caller is on the line after the agent returned to the line. Follow guidelines for Warm & Cold transfer. Agent returned to check on caller and provide updated hold time (best practice check after initial 2 minutes of hold).
Patients must fill 3-month supplies of long-term prescriptions at home delivery or specified in-network retail pharmacy. (For Cigna members specified Cigna 90 Now retail pharmacy.) **Not all pharmacies are in the 3-month network. If patients continue to fill 1-month supplies at retail, they will pay more.
Special Instructions: Educate the member on the following; retail courtesy fill allowance and selected In-network pharmacy (view Pharmacy Lookup).
Exclusive Smart 90 / Smart 90 Incentive-Choice
The statement, "Is there anything else that I can do for you prior to ending the call today?" is known as...
Nothing. This is close to the transitioning statement, but the transitioning statement inquires about whether there is anyone else that you can assist today prior to ending the call.
Note: This is one of the most missed items in our quality scoring.
No. Prior to transferring the call, you need to handle everything on your end that you are graded towards. This does include attempting to convert and going over medications that are available.
Note: Partially attempting to convert or not attempting to convert at all are commonly missed on Team Paige.
A mother called in to go over the medications of her child. Her child is 19 years old. How would you go about authenticating for the account and going over medications?
Authentication is sometimes a challenge with our team's quality. For authentication, you would need the mother to authenticate the son's account. Many times, agents ask the parent to authenticate their full name, DOB, and zip code. You only need the mother's full name and relation to the person that she is calling for (MOTHER). She will need to provide that child's full name, DOB, and zip code. Since her child is 19 years old, she would have to volunteer the names of that child's medications unless she is a PR. Do not release the names.