Systems
The system used to locate LEP letters
Medisys
This tool is required on every call
HIPAA Verification & Authentication Guide
Collateral or Correspondence
List of covered drugs
Formulary
Form that allows a members representative to receive PHI about the applicant for up to one year from the signature date
HIPAA Authorization Form
System used for finding LIS Status
Marx
SMART Tool
Used to order provider/pharmacy directories
GRS CustomPoint
Covered under Part B if administered for treatment of illness or injury
Tetanus vaccine
Period that begins 3 months prior to turning 65, the month of turning 65, and 3 months after turning 65
Initial Enrollment Period
System used to track member inquiries
Facets
Tool that provides guidance for grievances
Grievances Interactive Decision Guide (IDG)
Used to order Post Enrollment materials (formularies & EOCs)
EGR Collateral Request - Wellpoint (Shared Mailbox)
Moving a medication to a lower tier
Tiering Exception
This is also known as Part C
Medicare Advantage
This system houses member authorizations
MAS
Tool to access for help with questions (on a call, for help researching, and escalated callers)
2nd Level Help Desk
Used to request pre-enrollment materials (Welcome Kits)
GRS Collateral SharePoint site
May be required for medications that have generics available
Step Therapy
e-Breach form
System that houses member documents
WCF (Central FileNet)
Tools that house policies and desk level procedures
Knowledge Library & Atlas
Process to send HIPAA Authorization forms
Printed and mailed via CSR
Needed to add a non-covered medication to formulary
Formulary Exception
Type of calls offering a product, plan, or service not currently provided to the called party.
Sales