CALL FLOW/TYPE
This is done on EVERY call to ensure we can contact member.
What is verifying a good callback number/demographics?
"Before I let you go today, are there other medications which you are taking that we can mail to your home?"
What is Fence Sitter?
When would the member pay 100% of medication costs until they reach the $480 limit.
What is Stage 1 Deductible
Member needs override for controlled substance
What is warm xfer to HCPR?
Member is frustrated with back and forth between MD and Humana about a Refill/clarification request we have not received a response on
What is a follow up with the member and a request over to the A-team.
TAT is 3-5 days
What is expedited shipping?
Member fills all rx with CWP mailorder
What is #FSOD?
Humana and member pay medication costs until shared total equals $4,430
What is Stage 2 Initial Coverage
CWP Representative sees note that says "RX WAS INACTIVATED/DISCONTINUED"
What is a medication that can no longer be filled.
Steve has an ongoing issue that has not been resolved resulting in multiple phone calls to CWP
What is offer team voicemail so Steve has one contact until issue/case is closed
Refill order shipped regular shipping and order has not been received in 8 days
What is offer any available tracking updates and your team's vm if member does not receive order on time?
Member agrees to fill additional Rx with CWP
What is #FSOA and enter RTM reference number?
Member pays maximum of 25% of the cost of covered drugs
Stage 3 Coverage Gap/ Donut Hole
John is out of a medication that is currently in an order in QMSI status and needs a short supply from his LP
What is enter Mail order delay and warm xfer to Missing Rx
Jane has expressed that her call has been disconnected twice and she is feeling unheard
What is offer team voicemail with extension, and calling her back immediately to apologize in ACW if the call drops a third time
When member medication looks different or unsure what medication is used for
What is a Pill Id? Or what is a reason to direct transfer to RPH?
This is selected when transferring a caller to Clinical Services
What is "#FSCS"
Glucose meter, lancets, lancing device, test strips, nebulizer solution
What is Diabetic Supplies? (Not covered with PDP plan, must submit to Part B carrier)
Sara's order shows that a quantity of 180 tablets were shipped however she states she only received 160 tablets
What is Potential Misfill warm transfer to Clinical Services?
James calls in to refill all refillable rx and states how he sometimes forgets to call and refill rx that you notice are due within the next week
What is proactively anticipate James future needs by offering to place refills for rx that you see are due soon
Ensuring members do not have to call back for the same/repeated issue
What is one call resolution and offering a follow up?
Fence Sitter has been offered within the last 6 months
What is "#FSXX"
HEB, Kroger, Publix, Walmart, Sam's club offer rx for member at lower copay
What is preferred, in- network pharmacy?
Member received 90 tablets for a 90 day supply (rx on file) but states she is supposed to take rx 3 times a day (no new rx on file)
What is submit RTM for correct quantity and advise member that a new rx is required. (No transfer to CS)
Member you spoke with has a birthday and it is coming up on the 4th of July. You want to recognize is to show the member your appreciation.
What is send a Maximizer note card to member to share appreciation and positive thoughts for them on their special day.