MC INBOUND
Member name + 2 identifiers
Must also provide NPI/DEA number prior to the release of PHI
What is MDO Authentication?
"LM WITH MDO, UPDATED TO CORRECT PROVIDER AND FAX NUMBER (MBR SEES NEW PROVIDER)"
What is office rep's name, old provider's name, new provider's name, old fax#, new fax#?
THERE IS NO RX CLAIM FOR STATIN AT LP (WHERE MBR HAD REQUESTED THEIR STATIN TO BE SENT BASED ON THE PREVIOUS NOTE FROM LTR). THIS IS WHAT YOU WOULD DO.
What is CALL MDO?
Show Picture#1
What is code email with HID/NPI, check rxnova and epost for claims, dispo as md denied/mbr already taking (no claims, etc depending on the research) with note that states: Per IB fax from mdo Legault, checked off patient already taking and circled Rosuvastatin 20-40 mg and wrote, “Patient already taking Rosuvastatin 40 mg 1 PO QD” and signed by md. Then state the claims research (no claims, last filled date, REV, DNI, etc) THEN Move email to completed folder
Mbr confirmation/Adh Follow up/MPC/PU/PO/ Assist Opening IB tech with Faxing and Coding as needed/ Cover Opening IB tech breaks & Lunches then takeover at Openers EOD.
What is MC INBOUND closer?
“SPOKE WITH TRACY AT MD JONES OFFICE, STATED MBR SEES DR. JONES AT ANOTHER PRACTICE LOCATION”
What is alternative location information and was information was updated in the tracker?
RXNOVA SHOWS A REVERSED CLAIM AT LP FROM RX THAT WAS RECENTLY SENT THERE BY THE MD. EXPLAIN AT LEAST TWO SCENARIOS WHERE THIS MAY HAVE OCCURRED.
What is RX WAS NEVER PICKED UP AND HAD TO BE PUT BACK; MBR CHANGED THEIR MIND/DECLINED THE MEDICATION; THERE WAS AN ISSUE WITH THE RX ITSELF?
SHOW PICTURE#2
What is code email with HID/NPI, dispo md denied/contra with note that states:
Per IB fax from mdo ___, marked off the box, other and wrote, “LDL 48 without therapy”
Move email to completed folder
NAME OF MEMBER +3 IDENTIFIERS
What is Inbound Authentication?
“LM WITH ED AT MD SMITH’S OFFICE TO ADVISE THAT WE WERE UNABLE TO REACH MEMBER TO FOLLOW UP ON STATIN MEDICATION, NO RECENT RX CLAIMS PER OUR RECORDS”
What is statin name and strength?
RXNOVA SHOWS A RECENT PAID CLAIM AT LP, BUT MBR HAD REQUESTED IT TO BE FILLED THROUGH CWP BASED ON THE NOTES FROM THE LTR APPROVAL.
What is send transfer email to RSSTARS?
SHOW PICTURE#3
What is code email with HID/NPI – ICD fax needed, dispo md denied/contra with note that states:
Per IB fax from mdo ____, marked off the box Myalgia…and wrote: “Stop sending these. Pt can’t take statins” and signed it.
Update the email to include mbr name, HID, DOB, prescriber name and fax # and send to RSSTARS inbox.
Obtain name of member + 3 identifiers. Authenticate the authority of the caller by verifying 2 of the following: Name of Medication,Strength of medication,Rx number, order number, Date of fill or Presribing Provider
What is Implied Consent?
“CPTECH STARS LTR RETAIL INBOUND/OUTBOUND CALL. MBR APPROVED FILL FOR FOLLOWING MEDICATIONS: (rosuvastatin ) @ (cvs), SPOKE WITH EARL refill placed], IF ANY FURTHER QUESTIONS CALL CLINICAL PROGRAMS DEPT AT 1-800-532-3304. *MBR IS NOT CMR ELIGIBLE * AUTO-REFILL (YES/NO)*
What is type of call (IB vs OB), strength of rosuvastatin, CVS phone number, auto-refill Yes or No?
EPOST SHOWS THAT MDO DID RESPOND TO NEW RX REQUEST BUT DENIED THE REQUEST (MBR NEEDS TO BE SEEN FIRST).
What is CALL MBR?
SHOW PICTURE#4
What is code email with HID/NPI, dispo md denied/does not have diabetes with note that states:
Per IB fax from mdo Powers, marked off the box Prediabetes and signed it. Then move email to completed folder.
Check VM at start of shift/Coding/ Faxing ICD/Repatha and Manual faxing Excel Sheet/ MPC/ PU/PO while idle
What is MC Inbound Opener
"In PU, added and assigned to new md at 123 Main St. Happytown, HI, 99999"
What is MD Name, where the new information came from (epost rx hardcopy, etc.)?
RXNOVA DOES NOT SHOW A STATIN CLAIM, BUT LP STATES THAT THE RX WAS FILLED AND PICKED UP ALREADY. LP INFORMS YOU THAT IT WAS BILLED TO UNITED INSURANCE AND ALSO HUMANA, HUMANA AS SECONDARY INS.
WHAT IS DISPO THROUGH MBR CONFIRMATION QUEUE—PART D NOT USED?
Only one page in the email/fax
What is search the tracker using MD name and fax # to find the correct patient. Code with HID(s)/NPI. Ensure that the mbr is still in the faxing queue, unless other communication is documented. Then move email to completed folder.