1
Where do we now go to insert any PTO/PST requests?
Verint
•1-877-800-0925
(Make sure that it is saved in your phone, please)
True or False: Agent is NOT required to provide Stage on Medicare Retention calls or when processing refills/renewals.
True.
What is a tip that you would provide to your peers on how to maintain your positivity on a day where it might be difficult?
N/A
What tips would you provide to someone that is struggling with conversions, or what question would you like to ask regarding obtaining conversions to the team?
N/A
Shift Bids will be coming back around this June. What can you do to increase your chances of receiving an offer?
For the 3 months prior to the offer, we are looking at attendance patterns, nice quality performance, good conversion numbers, and strong performance overall across the board.
What is a requirement for informing DOD beneficiaries about filling at the Military Treatment Facility (MTF)?
Inform DoD-beneficiaries that they are able to fill medications through a Military Treatment Facility (MTF).
Rule: ▪ MTF option does NOT need to be discussed when the beneficiary is calling in for a refill/renewal or is calling with the intent to convert.
Where can you go to find information on the MEDD Stages?
Prescription List >Home Delivery Opportunities>Select Medication Name< View Drug Coverage
or
Benefits> Drug Coverage> Search Medication Name> Select Medication
Note: The stage should be provided anytime pricing is given.
What are two ways that you can obtain Cigna Standout Points on the team?
Engagement
Performance
According to the quality guidelines, when is pivoting NOT required:
Pivot is NOT required when:
o The account is a Medicare account.
o The caller is verbally abusive or angry*.
o The caller is adamant that they do not wish to use home delivery *.
What was the updated Notify Your Prescriber verbiage?
What does checking for OHI on a DOD call entail?
Ask the member if they have any other health insurance that covers prescription benefits and navigate to Benefits and select the OHI tab.
(If not completed, this is a QSO)
When is the transitioning statement NOT required on calls?
Rules:
Agent is NOT expected to transition when: o The caller is verbally abusive or angry*.
o The caller is adamant that they do not wish to use home delivery *.
o The caller is listed as a surviving spouse on a DOD account.
o The agent is handling a Medicare D account.
What are the only 2 rules to the QSO category: Confirmed Accurate Patient Shipping Address?
Rule:
• When an address is updated, the agent must read it back to the member to confirm.
• When recommended address box appears agent must read and spell back the address to the member to confirm.
When recapping the cart, what about the medication should you mention to avoid missing points:
Medication Name, Strength, and Form. Missing any portion of that information about the medication can result in missed points.
What are the exceptions/rules to confirming accurate price of each medication, order total, and verified payment information? (8 points)
Rules:
• Agent is required to provide any existing balance listed in cart screen before processing payment.
• Agent is not required to review payment options on orders with $0 total.
• Agent is required to repeat credit card number back to the member when adding new card or verifying card on file.
What are some good ways to connect with a caller?
+Upbeat voice
+Personalize the call
+Control the call/Actively listening
+Be confident/Positive Banter
+Being relatable
+Don’t ask the member if they have time to talk, the response will almost always be no.
+Speak as soon as the call connects
+Follow the suggested scripting in your eDialer pop up window
What is the MEDD Privacy statement, which must be stated verbatim prior to getting three pieces of authenticated information?
"At Express Scripts (Cigna), we take your privacy very seriously. That is why we always ask you to provide some personal information to ensure that we are speaking with the correct person. I do want to let you know that you are not required to provide any health-related information to me and that the information provided will in no way affect your membership in the plan."
Agent MUST:
• Verify the prescriber’s Full name, street name, city and state OR prescriber’s Full name and telephone number when processing a conversion.
• Complete tasks related to updating the prescribers’ information to ensure prescription requests are sent to the office requested by the caller.
• Confirm prescribers’ FULL name and address when processing a renewal.
When a member declines a RPH Transfer, what should be done documentation wise?
When the member declines a RPH, a note must be entered in Smarttab, in addition to any other notes. You may have to copy/paste the declined RPH note and the call result note.
If not completed, you will be scored to under Utilized Proper RAD Codes & Smart Tab for CCD Documentation, which is a 3 point deduction.
When are conversions attempts not required according to the quality guidelines:
o Refills on the Order Now screen with a scheduled release date.
o The medications are already being filled at Express Scripts home delivery.
o The caller specifically states they are at the retail pharmacy.
o The caller is verbally abusive or angry*.
o The caller is adamant that they do not wish to use home delivery*.
o The account is a Medicare account.
o If agent fails to navigate to a list but it does not have any eligible medications listed.
What are some ways to overcoming resistance on a call?
+Step 1 Keep Calm
+Step 2 Let the Member Talk
+ Step 3 Acknowledge the Member
+Step 4 Ask Clarifying Questions
+Step 5 Confirm What You Heard (if necessary)
+Step 6 Reply to the Objection
+Step 7 Conclude and Close the Objection
When is it best to use the No Conversion Opportunities resolution code?
When to use:
Caller must be fully authenticated
Patient has no prescriptions listed in eSD that are able to be filled thru Express Scripts Pharmacy.
•Make sure to check claims.
•Make sure to check Rx List
Remember, if you refill/renew a medication you should select Processed Home Delivery. If you are experiencing high no conversion opportunities alert your leader.
The team is often scored off for not offering a RPH. What are some examples of when you should offer a pharmacist?
A member states that they are out of medication.
A member states that they are out of medication, but will figure it out.
A member states that they are out of medication, but their spouse has the same thing, so they will take theirs.
A member states that they have enough for 12 days.
A member states that they do not know what a medication is used for.
The caller states that they are allergic to a medication or had a bad response to a medication, therefore they do not want it.
Effective last week, the prescriber update (MDO) process has been temporarily suspended. How should you be handling prescriber updates?
Advise the patient to have their prescriber's office e-scribe the prescription to Express Scripts Pharmacy
Note: The Smarttab tool has been updated to temporarily remove the MDO Template.