Data Entry
Ind IN OOP is the short way of saying this.
What is the Individual in network out of pocket?
Used when agents state the deductible doesn't apply to the service or mention it's waived.
What is "Plan deductibles do not apply to this service."
This is what we should enter when told Humana Specialty Pharmacy.
What is Centerwell Specialty Pharmacy?
A tasty baked treat; or payer Intel.
What is pie?
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What is Turn Around Time?
The portion of the reference number shown here that is no longer used. "Bob D 10022024 1152am CST"
What is the time zone?
Used when we have attempted an escalation for COB type without successfully reaching a supervisor.
What is "Escalation attempt made, no supervisor available."?
When an Agent provides Specialty Pharmacy (PIE says SP not available), we use this task note.
What is "Representative confirmed specialty pharmacy is available."?
The smallest amount of 'digits' a PA approval number can contain before a push back is needed.
What are 6 digits?
napl rtsamdeinie yb presaeta tprteamedn
What is "Plan administered by separate department."?
The funding type we enter when told "Partially Funded", "Level Funded", and "Employer Funded".
What is Self Funded?
Used when approved PA units have been exhausted.
What is "Representative confirmed all units/treatments have been used on approved prior authorization."
The tab of the SOP we would use if trying to locate the phone number for Maxor Specialty Pharmacy.
What is the Xolair SP phone & fax tab?
Agent is unable to disclose the status of authorization on file or unable to disclose if any authorization on file, we should use this TN.
Representative could not disclose active prior authorization status.
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What is Contact Local?
The standard data entry for BCBS, when "How to be considered in network?" is unknown.
What is "Contact Local"?
Used when we are calling BCBS TX, but the provider's state is CA. (Specialty Pharmacy)
What is "The local BCBS Specialty Pharmacy will be determined upon approval."
This is the 10 digit phone number for Bioscript Specialty Pharmacy.
What is 866-788-7710?
They are the only insurance company we can say "yes" to when asked if the provider will buy and bill.
Who are BCBC Massachusetts?
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What is the Ocrevus PA Flow Chart?
An area of the call that it is ok to use dashes when entering in this field.
What is the group number?
After escalation, agent states we need to contact TPA to get the PA information.
What is Payer unable to provide prior authorization and predetermination requirements. Contact XXXX Department at XXXXX.
A type of task where once the call is submit, it will create a new task for the PBM benefits with the information we have entered.
What is a Chained Task?
Banner Network, DMG Health Partners, and Advocate Good Shepherd are all examples of this.
What are medical groups?
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What is multibenefit?