GPS
VUE360Rx
Four Horsemen
CxOne
Everyone gets an edit
Mystery
100
Where is this document located?
What is: TX VPM>Documents>Workstream Documentation> Pharmacy Operations (M&O)>DLPs>Call Center Workstream (Final DLPs)
100
How many criteria does VUE360Rx poll to determine if the drug is payable?
What is 9?
100
Which (2) of the following are NOT one of the Four Horsemen?
A. Criticism B. Sarcasm C. Contempt
D. Defensiveness E. Stonewalling F. Stubbornness
B. Sarcasm and F. Stubbornness
100
True or False: Agents must be super careful not to hang up on callers in MAX Agent when they are on hold.
False: The system protects agents from this unfortunate ending by not allowing callers on hold to be hung up on.
100
Allowed Refills Have Been Used
7216
100
What is the Diagnosis Code and Description for Auth ID 000000676?
Show us the way!
B18.2, Chronic viral hepatitis C
200
Where is this document located?
What is: TX VPM>Documents>Workstream Documentation> Pharmacy Operations (M&O)>DLPs>Clinical Workstream (Final DLPs)
200
What edit hit on claim ID 23311P010000701?
7702
200
ID the Horseman and Rephrase the Phrase:
Well, why did you click that button? If you had clicked the Member Tile, you would have gotten what you needed much faster.
Criticism.
“Oh, I see. It looks like the Authorization Tile may have been selected. Let’s see what happens if we click the Member Tile, instead.”
200
What feature allows you to view and change status options?
Drop-down menu
200
Lock-In
7121
200
Show me! How many Attributes does the Provider NPI 1336228006 have?
4
300
Where can you find these fields?
VUE360Rx>NDC Maintenance Tile>NDC Details>Addl Info tab
300
How many results populate when you search for Member Last Name: Training
16
300
ID the Horseman and Rephrase the Phrase:
I don’t have time to listen to you blame me for your mess up. I’m hanging up.
Stonewalling mixed with a little defensiveness.
“I apologize for that miscommunication. (take a second for a breath) I should have explained this in a different way. Let’s try again.”
300
Where can you see all calls waiting in MAX Agent?
In the queue.
300
ER Sev 1-Contact {1}
7073
300
Navigate to Claim ID: 23310P010003301. How many DENIAL edits are there on the claim?
7. 2 are set to Warn.
400
Where can you find this table?
VUE360Rx>Rx DUR>Severity Ranking
400
What is the severity level of this drug interaction?
3
400
ID the Horseman and Rephrase the Phrase:
Why don’t you just call the MCO instead of calling us? That’s what I would have done.
Contempt.
“Members with multi coverage can be difficult to figure out. You’re doing awesome being so patient. Let’s try to find that contact info for the member's MCO, and see if that helps us.”
400
Clicking on what icon within MAX Agent allows you to access help?
The question mark icon.
400
EO Early Refill Already Been Used
7289
400
Navigate to claim ID: 23304P010001001. What is the Rx Number for this claim?
021619120622
500
Where is this located?
Process Manager>Document Publisher>Add supporting documents
500
How many INPROCESS calls are there from 1/1/2024 to 1/31/2024.
52
500
ID the Horseman and Rephrase the Phrase:
I didn’t click anything. You must have done something on your end.
Defensiveness.
“I’m sorry! It looks like we ended up on a screen we didn’t mean to get to. Let’s try a different method, shall we?”
500
What shows your most recent calls on the MAX Agent main screen?
Call History
500
Gender Restriction
7111
500
Navigate to Claim ID: 23310P010004401. What is the calculated Amount Paid and Basis of Cost for this claim?
Amount Paid: 17.49
Basis of Cost: NADACG