ENROLLMENT
Gender is specified
When caller states Mr. or Mrs./ He or she
No active enrollment
Medication was dispensed prior to patient being enrolled or pharmacy input member ID incorrectly
Where would you go to get to benefit investigation results
Under quick links
True or False
Only one partner has to be over 65 and retired to qualify for PAP
False
Are BOTH you and your partner over 65 years of age and retired
What should you do when interrupted by the caller
Yield, acknowledge interruption and allow the caller to continue
True or False
You can NOT continue with enrollment without an HCP
False
Pharmacy Not Contracted
Pharmacy may not be participating in the PAP program. Confirm with a contract analyst whether or not if they are contracted.
What is located under the insurance quick link
Processing details
When creating a manual BIR, under insurance demographics, what rank should be selected?
Primary
What step do you take when placing a caller on hold
Ask permission, set expectation, meet expectation
Tabs that are required to complete while creating an account
New Patient, Patient Demographics, Case Creation
Other coverage code invalid/Other coverage code not supported
Have the pharmacy try putting a “00”, “01”, “1”, or “0” in the OCC field.
Where would you go to add the prescription
Into case, click the pencil to add prescription
Caller advises you that they have Medicare and commercial BCBS that covers their prescriptions. Which program would they be eligible for?
USG PAP Voucher
What must be offer with contact information and hours of operation at the end of the call
Additional assistance
What needs to be created when enrolling a patient into any program over the phone
A Patient account and Financial assistance case
Cash patients are not allowed for other coverage code or cash payment not allowed for the copay program
Verify that pharmacy is running Copay card as secondary. Patient might be enrolled in the wrong program. Ask the 4 questions. Last resort is IQVIA.
What's the number of stages in a case and name the stages that we work
5 stages
Enrollment, BIR, financial assistance and triage to pharmacy
Which is the correct NDC for Paxlovid 300 mg
0069-5321-30
When a caller expresses concern regarding an issue what must be provided
Empathy
Name the referral sources required to complete enrollment
Caregiver, Patient, HCP, Pharmacy
Product not covered
Ensure that the pharmacy is using the correct NDC
Where are Notes located in sales force
Bottom left hand corner
True or False:
A Manual BIR is needed if patient advised they are uninsured?
False
How do you demonstrate willingness to help
Provide a recap