Nightmare Costs
We ask for this when the agent cannot provide an ammount for Copay
What is Coinsuransse percentage
On RX group # and Group ID # (are the RX group# and plan group # the same)
Where can we find the phonetic alphabet for EVA?
Abbreviations Tab
Where are we calling from?
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What is coal
“The copay is much higher than expected, is that based on an estimate?” when do we ask this?
What is Copay is 300 or above or an ammount with cents
What do we prompt when medication is not covered, for either 30 or 90 days?
Can the medication be covered with a prior authorization?
Tier is higher than 2, what do we do?
Ask if there is a tier lowering exception proc process
We are calling at the request of who?
The provider
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When ever copays IS based on an estimate we also ask what?
Would you be able to provide a general cost share structure?
If both supplys are not covered, what are we supposed to ask?
Does this plan provide coverage for other biologic medications?
When do we use "by the way im not starting a PA just inquiring about the submmition process if applicable"?
When agent wants to transfer us to PA dep to star a new PA
Agent asks for the national provider identification, what do you provide?
The NPI!
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If agent says “Yes” to "is it based on an estimate?" what other thing are we supposed to do?
Go back to copay tab, mark yes and headset ammount
Agent states, this medication is not covered under pharmacy only Medical.
We GE and submit as complete
We do not ask for cost share when policy type is...
Medicare
Agent does not find the patient with the ID. What do we do?
Promt "I seem to ave a wrong ID, could you do a name and DOB search?"
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What do we do when copays for 30 and 90 days are different and both based on estimates?
We will leave an External Customer TN
Cost Share for 30 Day Supply: XX.XX ($300)
Cost Share for 90 Day Supply: XX.XX ($244.29)
Prior authoriation is required, but agent says there is one denied, what do we do with this?
Ask is there an active one
Where is "is there an active one?"
Hover Prompt in PA status tab
Agent asks for a medication that the patientis taking, what medication do you quote?
what ever is the medication that we are talking in regards (Tremfya, Stelara, etc.)
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