Assist Lines
This is who you call when MDO is requesting a Peer-to-Peer and there is a pending Appeal on file.
What is Escalation/Appeal?
The main purpose of an inquiry call is?
What is providing a status check on a medication or PA?
This happens when a medication is not covered under the member's plan.
What is Managed Formulary - Not Covered situation?
What you should offer if a PA is not on file or expiring within three months.
What is offering to start a new PA over the phone?
We transfer MDO to this Department when the member is Not a PA Client and has 7117/7118.
What is FEP MPDP Customer Care or F10 Extension?
You call this line when there are Clinical questions from MDO.
What is RPh Line?
This must always be done first on an inquiry call.
What is verifying the member and caller?
The drug class selected when a medication is not found in the dropdown list.
What is “OTHER”?
A word you should avoid using when explaining PA outcomes to callers.
What is “denied”?
We transfer Members to this Department.
What is CSU or F20 Extension?
This is who you call when you need extra time on a PA.
What is Supervisor Assist?
Information you must ask from the caller before releasing information to them.
What are Caller's name, title and where they are calling from?
The official explanation given when a caller asks why an FE cannot be completed over the phone.
What is that it is a forms-only process for all non-covered medications?
The question you ask before ending the call.
What is “Is there anything else I can assist you with?”
We transfer MDO to this Department when they ask for help with CoverMyMeds.
What is ePA CoverMyMeds Help Desk or F28 Extension?
You call this line when you need help with a PA.
What is Assist Line?
This group you cannot release PA information to.
Who are third-parties or pharmacies not within the MDO?
What tools must be opened early in the call to determine coverage and restrictions.
What are CAS Drug List and Work Instructions?
You should do this when you need more than 1 min of time to research during a call.
What is ask caller if you can place them hold?
We transfer MDO calling for Vacation Override to this Department.
What is CSU or F20 Extension?
This is who you call when the caller is asking for a Supervisor.
The classification selected when documenting a status check call.
What is INQUIRY – CHECK STATUS?
The outcome selected when the caller is unsure about switching or does not want to switch medications.
What is Managed Formulary – Not Covered?
You should never do this to a caller when they are taking too long.
What is hang up on them, or try rush them?
We transfer MDO to this Department when MDO wants to set up Mail Order for a NEW Medication.
What is Caremark Mail Order New Rx or F23 Extension?