CRM
How can you tell a GA & Verify demographics is available in the account?
Shows a yellow-orange blow horn & warning sign
What credentials are needed when signing in to OMS?
Advocate's Humana User ID & Humana password
Why do we run a test claim?
To check if we can claim the medication today and if not what could be the reason for the error
What information is needed to pull up the member's account in RxConnect Pro?
The member's Humana ID
In what tool can you check the benefit type of the member?
CRM
How will you know an account has been authenticated already?
It will show the green toggle button in Interaction Log
What button should you click to go back to the home page of the member's account?
PATIENT in the upper right corner
What are the 4 claim status stating we can place the order for the member?
PAY, PAC, CAC, and PWE
Where can you check the current plan stage of the member?
Under "Stage Tracker"
To check the OTC coverage of the member what should you click in CRM?
Pharmacy Benefits & Authorizations
In a live call, what should you click after pulling the right account, authenticating the call, toggling the authentication button?
Click the "With & About"
Where can you see the ledger of the member or their payment history?
AR/Accounts Receivable
080 & 023
Where can you see all the medications of the member?
Under Medication List
What's the coverage of OTC under RxNova?
Approved OTC wellness and health products under CWP
Where in CRM can you see if the member has a consent form or HIPAA form?
It will show under HIPAA forms
When would be a free expedited shipping provided for the member?
When the delay was caused by Humana
What is the maximum DS when processing an MOO?
30 days
When sharing the drug pricing what should you make sure to include into your statement?
"Estimated amount" and "plus any applicable taxes"
What's the coverage for healthy options?
Approved OTC health/wellness products, house utility, and groceries.
First name & Last name of the patient, 3 identifiers, and 2 implied consent identifier alongside the first and last name of the third-party caller
What are the changes can be done to the order if it's not yet in QMSI?
Shipping Method & Order Status
When should we process a VOO?
To provide enough medication supply to the member when they will be going out of town.
What department should handle the guidance for drug alternatives?
CS Tech
5-7 business days from the day after the order was placed and EMME