WORK INSTRUCTIONS
Provides a foundation that gives representatives control of their call and helps them to create a positive caller experience.
Universal Care - Consultative Call Flow (CCF) Process
This tool is used to access work instructions that provides CCRs step by step information on how to resolve a call based on member's inquiry.
theSource
A 10-day supply of medication(s) provided to members through a CVS Retail Pharmacy.
Bridge Supply
How many Lost/Stolen/Damaged overrides are allowed for a State of IL member?
One per drug, per plan year
Provides the process used when a plan member contacts Customer Care to refill a Mail Order prescription or renew a previous Mail Order prescription.
Aetna Compass - Mail Rx Refill/Renewal (Order Placement)
CCRs used this system to order medications, check plan coverage, pharmacy network etc
Compass
A __________ refers to problems with the way a prescription was translated, or filled, which poses a potential danger to the member.
Class 1 Error
This custom website is used when ST of IL members need to verify coverage and benefits.
Provides CCRs with the steps to follow when a Senior Team outreach is needed.
Universal Compass - Initiating an Assist (Slack Users)
System to verify QA scores and Supervisor evaluated calls
Verint
A request for coverage of a medication that requires the beneficiary to try one or more similar lower cost medications to treat their condition before the plan will cover the prescribed medication.
Step Therapy Exception
ExtraCare Health Card's are available for ST of CT members. (True or False)
False
This document outlines the research steps to be followed when the CCR is faced with an issue regarding a claim adjustment request, refund check, or invoice due to the claims reprocessing effort or when submitting an adjustment, when applicable.
Compass MED D - Claim Adjustment and Refund Requests
This Medicare Advantage Prescription Drug Eligibility system will assist MED D CCRs in verifying:
Part D enrollment and eligibility for Medicare eligible beneficiaries
Low Income Subsidy information for Medicare eligible beneficiaries
MARx
The _______ is intended to provide access to healthcare coverage for all, with a goal of lowering the number of uninsured citizens and thus reducing overall healthcare costs.
Affordable Care Act
Starting 1/1/2026 _________ will need a Prior Authorization (PA) in certain situations. Both ST of CT and ST of IL.
Lorazepam/Alprazolam