Medicare GLP-1 Bridge Prior Authorization Calls
If the response is incomplete or incorrect information, what do you tell the provider?
Resubmit the prior authorization request using the required standardized form. Confirm all necessary information is included.
Will medications needed from the side effects be covered?
All decisions related to health benefits, potential side effects, and available treatment options should be discussed with your healthcare provider and submitted to your Part D carrier for review. The Medicare GLP-1 Bridge provides coverage exclusively for GLP-1 medications.
What does the HEAR Acronym mean?
H = Hear the inquirer
E = Empathize
A = Apologize
R = Resolve the issue
When do you offer the case number to a beneficiary?
f the call is disconnected, the caller will receive a call-back. Or when only one case must remain open.
When filing a complaint, what complaint type do you select?
Non-Behavioral/Non-Medical
After accessing PAHub, what do you search by?
The Medicare Beneficiary Identifier (MBI) or name
My doctor won't write me a prescription for a GLP, what can I do to get this medication?
If your doctor doesn't write you a prescription for a GLP-1 medication, you won't be able to access coverage through the Medicare GLP-1 Bridge. A valid prescription from a licensed healthcare provider is required.
When callers threaten themselves (suicide) or others, or they have an urgent emotional need, what do you do?
Notify your Team Lead or Supervisor of the situation, calmly advise the caller that you're here to listen, and confirm the caller's current physical location and callback number, if able.
When do you provide the interaction number to a beneficiary?
Provide the interaction number when the caller asks, "Is there a number I can have to reference this call?"
Offer the interaction number when 2 or more cases must remain open.
Error code 007: Pharmacy Not Eligible For Payment on Date Filled received, what do you tell the caller?
Tell the caller that the pharmacy is out of network.
After clicking EOCID link what displays?
The EOC Details screen displays.
What is a BMI?
Body Mass Index (BMI) is a screening tool that estimates a person’s body fat based on height and weight.
If the caller requesting to speak to a supervisor, and one is not available what do you do?
Apologize to the caller with sincere empathy. Advise the caller, you've requested a supervisor; however, they're assisting other callers and not immediately available. Ask if the caller willing to accept a call-back.
What kind of number is offered to providers calling for reference to the call made?
For most calls, it can be better to offer the interaction number because the provider tends to call about multiple beneficiaries during one interaction.
Error code 013: Ingredient Cost Greater Than Allowed By Plan received, what do you tell the caller?
The cost of the medication is more than allowed and requires clinical review. Prior authorization must be submitted by the doctor.
If the EOC is approved, what do you tell the caller?
The prior authorization is approved and maintain active Part D coverage to remain eligible for the Medicare GLP-1 Bridge.
What pharmacy can I work with to get my medication?
You can fill your GLP-1 prescription at your existing Part D network pharmacy or any pharmacy that accepts Medicare Part D plans.
What Mentor is used if you have a caller that is angry and using profanity or offensive language and have been warned twice?
Medicare GLP-1 Bridge Disconnecting the Call
How do you link GLP-1 cases?
Select the checkbox for 2 or more cases to be linked in the Link column.
Click the Link Cases button
Error 080: Claim in Error - RTS received for vacation override, what do you tell the caller?
Tell the caller that the pharmacy can resubmit the claim with the vacation override code.
If the EOC is denied, what do you click to review the notes?
Click Full Report to review the notes.
Can I send a prior authorization before the July 1, 2026 Medicare GLP-1 Bridge start date?
Prospective prior authorizations won't be accepted.
If the caller requesting to speak to a supervisor and they are available, what do you advise the caller?
A supervisor is available who will assist. You'll bring the supervisor on the line after sharing the details of their concern. f the call is disconnected, the caller will receive a call-back.
How to you send a task?
Error code 190: Quantity does not match drug package received, what do you tell the caller?
The quantity submitted doesn't match the manufacturer package size and the package shouldn't be broken or split.
The pharmacy must update the quantity to the correct package size of the drug they are trying to bill.