RTM
Provide 2 Benefits
90 day Supply, Refills 4 x's a year, No cost for shipping, Refill reminder calls
What is the Client expected time for advocates to answer calls?
5 Seconds
How do you recap a refill order and what all should you include?
RECAP the member's order by confirming the following information: Make Changes as needed.
*Names & Strength of each medication (including RXs set to auto-refill)
*Complete shipping address(2nd time on address)
*Verify the member's Complete Address and name the order will go to (3rd time)
*Shipping address validated/read from order screen shipping address.
*Offered order #.
What does State CenterWell Pharmacy mean?
Centerwell Pharmacy, Formerly Humana Pharmacy
How do you get a Dual Enrollment?
By asking is there anyone else is the household that can benefit from Centerwell Pharmacy today
What is the Verbatim for the Absolute "Yes"
Yes to Fax the provider, Fill prescriptions through Centerwell Pharmacy, and obtain the Rx from the local pharmacy is necessary
Is "How are you doing today" enough to build rapport? and what else should you do?
No, Listen for opportunities to personalize the interactions (background noises, kids, dogs) and or responding to the member's comments that give an opening for building rapport.
What is the Refill Information?
refill 5-7 days, renew/expired 7-10 days after CWP receives the prescriptions, New Rx 7-10 days. WISMO: 5-7 refills, 7-10 new Rx.
provided refills remaining on all medications/DBS refilling
How can the member obtain Refills?
Mobile App, Website, IVR & Call
How can you show respect for the member?
Use courtesy words throughout the interaction when asking for and receiving information.
Use the member's name at least once during the interaction. If the advocate uses the caller's first name, they must ask for permission before doing so.
What do you Follow if RX is not on File?
Missing RX Process
What are the 3 Key elements to the Absolute yes?
-Fax the provider
-Fill with CenterWell Pharmacy
- Obtain prescription from local pharmacy if needed
When should you ask about Diabetic Supplies?
When Tab is Plum
What is the Definition for "Provide all advice and information other than med and pricing on client checklist?
Advise member to let their doctor's office know of the fax request
• New prescription TAT 7-10 days from the time the prescriptions are received from their provider.
• When applicable provided account limit info - "If the account limit of $200 is exceeded advise the member CWP would require a payment before the order ships and they will receive an automated phone call".
• If order co-pay over $0 offer to add card and “If YES, Inform member their card will not be charged until the prescription is filled
• Auto refill info- All call types- if enter RTM.
Name 2 things you should do on EVERY call that is Very important.
Authenticate caller if not Welltok & Transition to RTM
What form Question is this "Attempt to offer all eligible medications (shaded in GREEN and YELLOW), by medication name and strength (don’t just ask member generic "What medications would you like refilled?”) Educate the member on Humana RX, do not assume local is a preferred option and refrain from stating, "I recommend you keep this antibiotic/controlled substance at your local pharmacy."
Offer/State all Eligible medications listed
What is your Closing on a NON-Enrollment call?
Your decision today has no impact on your plan membership.
What is your closing for RTE, IB, and OB, Including if they are not interested?
RTE- Must mention survey, brand the call and thank member.
IB/welltok/RTE- Not interested- No impact statement "Your decision today has no impact on your plan membership". (Must be delivered somewhere in call if not interested)
IB/welltok- Interested closing where it is required to provide the member with the CenterWell CS phone number and hours of operations.
What is the New Definition for Did the advocate confirm the Shipping address, on IB and Outbound calls?
New- Recap Medications and Doctor's information and full shipping address prior to absolute Yes- (IB, Welltok)
What weak phrasing and vague expression should you avoid?
“I think”, “maybe”, “it should” “I don’t know”, “I’m not sure”. Try to avoid vague expression such as "umm", "humm" or any other that may cause confusion or show insecurity.
on a Refill call, What do you need from the member?
Implied Consent
What is "You can use any pharmacy in your Humana plan’s network. However, please let me know if you are interested in using CenterWell Pharmacy for any of your additional prescription needs.
Humana Network Disclaimer?
What are all Required Verbatims? Minus the absolute yes
“May I have your permission to view your Humana prescription claims in order to give you an estimate?"
“This one-time permission is voluntary, and your decision today has no impact on your plan benefits."
“The prices I'm about to give you are only an estimate based on your current prescriptions in our system at this time. Actual costs are determined by your prescription drug benefit, the quantity, strength, and dosage of the medication along with the order or stage you are in when your medications are purchased plus applicable tax. Also, your decision today has no impact on your plan membership.
Not interested "Your decision today has no impact on your plan membership"
To protect your privacy, we don’t include medications names in emails without your permission. By choosing “Yes”, you can receive the names of your medications in the emails we send you. This includes medications used to treat sensitive condition.
“You can use any pharmacy in your Humana plan's network. However, please let me know if you are interested in using CenterWell Pharmacy for any of your additional prescription needs. "