Transfers/OB Calls/Interactions
If you receive an unauthenticated call and are able to authenticate the member, when you update the Authentication Indicator in CRM and click Save, it switches from red to green and the status is saved for any associate you transfer the call to. However, the Interactions Display in the CRM Genesys Softphone Phone window still displays?
Unauthenticated
How do you create an interaction with a beneficiary for GLP-1?
Search for the beneficiary on the Member Search tab using their Medicare ID number or other identifying information. Select the appropriate Interacting With/Interacting About options from the right side of the Results section. Select the checkbox next to Create a case NOT associated to an available Member Plan from the Interaction History tab. Click New Case.
What is a Power of attorney (POA)?
A legal document signed by a beneficiary to allow another party to act on their behalf.
After accessing DomaniRX, what do you click to check eligiblity?
Click Eligibility & Hierarchy from the Menu drop down.
What is considered necessary information to search for a claim in DomaniRX?
Rx number
Date of fill
Pharmacy name
Drug name
Patient name
You must not change your status during an active call. Statuses are only changed after the call has ended and you've entered the Wrap Up stage, before clicking the Done button. Why?
Changing the status before the call ends causes the system to start calculating ACW time prematurely.
What information is required to create an interaction for an unknown Agent or Broker?
Agent or broker type, first name of the agent, when the agent type is Broker, last name of the agent, when the agent type is Broker, account name, when the agent type is Agency, and the State.
If the beneficiary is deceased, the Power of Attorney (POA) becomes invalid. In this situation, the caller must attest that they are the?
Legal Executor of Estate (EOE).
Do you enter the Group ID when filling in details from Member Home in DomaniRX?
No, the Group ID field is left blank.
After clicking Claim ID what will display?
The Claim Detail page displays.
What conditions should apply before making an outbound call?
You have already successfully launched the Genesys Cloud desktop application and you are not actively on a call
What information do you need to gather for an unknown GLP-1 Bridge beneficiary?
ID: Type the beneficiary's Medicare ID (the caller may refer to the ID card as the "red, white, and blue card").
First Name
Last Name
Date of Birth
Mailing Zip/Postal Code
Home State/Province
Home Phone: Type the beneficiary's callback number.
You create a separate case in CRM to document the POA information using what classification and intent?
Classification: HIPAA
Intent: POA / EOE
After entering the Medicare ID number in the Member ID field, what is your next step?
Check the box that says Exact Match
Error 034: Prescriber ID is invalid shows on claim and no other error codes, what do you do?
Contact the pharmacy and ask them to:
Check the prescriber NPI format and value.
Resubmit the claim if possible.
What is the Voiance toll-free phone number and pin for foreign language calls?
(855) 680-1056 Pin 9937
When an unknown Beneficiary cases are created and the Complaint selected is Yes, will the case auto-routed?
The case isn't auto-routed to the Resolution team because the complete member details aren't available to work the case. On the Case Edit page, the owner of the case remains as the associate so that the associate knows that the case wasn't transferred.
What details need to be documented for POA in the CRM case notes?
Name
Mailing address
Relationship to the beneficiary
Phone number
After click the hyperlink that matches the beneficiary's information, a new window opens displaying what information?
A new window will open and display the members' demographic information.
Error code 261: Prescriber Currently Sanctioned is showing on claim, what do you tell the caller?
Tell the caller the prescriber has an active federal sanction. CMS prohibits payment for prescriptions prescribed, dispensed, or furnished by excluded individuals and entities, including the prescriber.
If GLP-1 Bridge system is down with an unknown "fix" time and approved by your supervisor, what should you tell members?
What information is required for an unknown provider?
Classification for the provider, first name of the provider, if the provider classification is Individual, last name of the provider, if the provider classification is Individual, and name of the account, if the provider classification is Group or Facility.
What attestation statement needs to be added to CRM Case notes?
The Caller has attested that he or she has the authority under State law to request information on behalf of the individual, and that proof of authorization, if any required by State law that empowers that individual to effectuate a request on behalf of the beneficiary, is available upon request by the PDP sponsor or CMS.
What 3 elements of information are needed to authenticate a beneficiary for GLP-1 per Medicare GLP-1 Bridge HIPAA Job Aid?
First Element: Medicare ID Number
Second Element: Member date of birth
Third Element: Member address or ZIP code
Error code 177: Use Appropriate Tab or Cap Strength for Dose, what do you tell the caller?
Tell the caller the beneficiary should discuss the dosage with their doctor.
If a different dose is appropriate, they will need a new prescription.
If they must take the current dose, prior authorization must be submitted by the doctor.