Mail Order Status
Member calls for a status on their refill. You see that the prescription is placed on indefinite hold. There are no refills remaining. Do you use the Mail Rx Tab or submit for a New Rx?
From the Claims Landing Page, click the Mail Rx tab. Proceed to order the Rx.
Content ID : TSRC-PROD-064251 Aetna Compass - Placing/Releasing a Prescription (Rx) in Process on Hold/From Hold
Barb E. Dahl is requesting a refill for their Atorvastatin 20mg but the prescription is not located on the actionable tab, what is your next step to get their refill?
Click the Rx History tab to view other prescriptions.
TSRC-PROD-064266 Aetna Compass - Mail Rx Refill/Renewal (Order Placement)
What three places can you initiate an EPA in compass?
The Claim Details/Transmission Details screen, The Claims table (only if a valid PA rejection is on the claim), and A test claim (only if a valid PA rejection on a test claim).
TSRC-PROD-064961 Aetna Compass - Initiating an ePA Request
What should be done after determining the reason for the call?
Account wellness check; Check phone and email address.
CMS-PRD1-095822 Universal Care - Consultative Call Flow (CCF) Process
Before placing a New prescription request, how many day supply should a member have on hand?
At least 10 days.
TSRC-PROD-064255 Aetna Compass - Obtaining a New Prescription (Rx) for the Member (New Rx Request)
If the member calls to update shipping address for mail order Rx(s) in dispensing status, what process would you follow?
If the Rx Status Description states, “We are dispensing your prescription,” DO NOT change the address on the order. Send a manual Stop Tote email with the updated address included in the email.
TSRC-PROD-064294 Aetna Compass - Mail Order History / Order Status
When placing a refill and the requested shipping address is not available in the drop-down menu who is allowed to make changes?
Only members (and designated individuals such as POAs) can make these requests.
TSRC-PROD-064266 Aetna Compass - Mail Rx Refill/Renewal (Order Placement)
What two things must you verify before initiating an EPA request?
Verify that a test claim has been run and a PA or exception is required & Check to see if there is an existing PA or exception request for the medication.
TSRC-PROD-064961 Aetna Compass - Initiating an ePA Request
What is the maximum amount of non-interaction time not prompted by the caller?
20 consecutive seconds.
TSRC-PROD-064305 Aetna Compass - Basic Call Handling (Greet, Warm, Cold, Call Hold and Close Call)
What disclaimer must you state after placing a New RX request?
We need to contact your provider for a new prescription. You can expect your order to be shipped from our pharmacy within five business days once it is received, provided your provider responds. Orders ship on the first business day available upon processing being completed.
TSRC-PROD-064255 Aetna Compass - Obtaining a New Prescription (Rx) for the Member (New Rx Request)
What is the turn around time verbiage for mail order refill request with no refills remaining?
If the Rx has no refills remaining or is expired: We need to contact your provider for a new prescription. You can expect your order to be shipped from our pharmacy within five business days once it is received, provided your provider responds to our request. Orders are shipped on the first business day once processing has been completed.
TSRC-PROD-064266 Aetna Compass - Mail Rx Refill/Renewal (Order Placement)
What are the 4 categories you need to verify before submitting the refill request?
1.All Prescription information (Medication Name, Strength, and Quantity, Available fills, Prescriber Name)
2. Shipping Address
3.Phone Number
4.Payment Method
TSRC-PROD-064266 Aetna Compass - Mail Rx Refill/Renewal (Order Placement)
If a member is requesting to backdate a PA, how should you proceed?
Contact the Precertification Department for assistance. If they are unable to backdate the PA, refer to Aetna - Initial Benefit Review (IBR) Process for non-PA Benefit Rejections.
TSRC-PROD-064313 Aetna Compass - Handling Prior Authorization (PA) and Formulary Exception Requests (Electronic Prior Authorization / ePA)
What is the verbiage you use when you have to put a caller on hold?
I want to ensure we have an accurate answer for you. I will need to place you on a brief hold while I work to resolve this. May I check back with you in about 5 minutes, or would you prefer I check back sooner?
TSRC-PROD-064305 Aetna Compass - Basic Call Handling (Greet, Warm, Cold, Call Hold and Close Call)
Emma Wifey is requesting a new Rx for her spouse. The existing payment method is on file. Can you proactively verify the payment method on file?
No, If you are speaking with an authenticated third-party caller, ask them to provide the payment method information. DO NOT proactively offer this information.
TSRC-PROD-064255 Aetna Compass - Obtaining a New Prescription (Rx) for the Member (New Rx Request)
Member calls to check 3 Rx's doctor submitted for Mail Order and wants to cancel 1 Rx with $250 copay. Do you cancel the order and re-submit?
No, advise the member you can cancel the one RX and Recap the order to be processed.
TSRC-PROD-064391 Aetna Compass - Editing and Canceling Entire Orders and In Process Orders
TSRC-PROD-064138 Aetna Compass – Split Order or Remove a Prescription (Rx) from an Order
Ella Vader has called in to place a refill request for her husband Darth Vader and wants to split the payment to 3 different payment methods. What would you advise the caller?
Advise that No more than 2 different payment methods can be used to pay for an order.
Content ID : TSRC-PROD-064551 Aetna Compass - Split Payment (More Than One Method of Payment) for an Order
After reviewing the general notes from a PA denial, the member request more information on why it was denied. What do you do?
Warm transfer to the Prior Authorization department.
TSRC-PROD-064435 Aetna Compass - Viewing ePA Status and ePA FAQs
What is the last thing you should do before closing the call?
Recap the call.
CMS-PRD1-095822 Universal Care - Consultative Call Flow (CCF) Process
Liv Long is calling in to place a new Rx request and she is wanting a portion of her order to be shipped to a different address. How would you proceed?
A separate New RX Request is necessary when a portion of an order needs to be sent to a different address. Complete the current New RX Request before returning to Step 1 and submitting an additional New RX Request.
TSRC-PROD-064255 Aetna Compass - Obtaining a New Prescription (Rx) for the Member (New Rx Request)
Member calls in to check status of mail order Rx. The order cannot be found. What is your 1st step?
Verify with the member that they do not have any additional active accounts or any recent name changes.
TSRC-PROD-064294 Aetna Compass - Mail Order History / Order Status
Chris P Bacon Calls in wanting a refill for themselves and their minor child, what is the first step you could take to process a refill for multiple members?
Authenticate all members.
Content ID : TSRC-PROD-064266 Aetna Compass - Mail Rx Refill/Renewal (Order Placement)
Summer Tyme calls in to check the status of her Prior Authorization, however you are unable to locate the Prior Authorization status in compass. What do you do next?
If you cannot locate the PA request in Compass BUT the caller states that Customer Care already submitted an ePA request, refer to the In progress procedure below and document any new ePA requests as a second attempt. CCRs should only submit a maximum of two ePA requests for the same medication.
TSRC-PROD-064435 Aetna Compass - Viewing ePA Status and ePA FAQs
Ray Zenz is calling about a medication. What 3 questions should you ask the member?
1. What medications were you calling about?
2. How many days’ supply of medication do you have on hand?
3. How can I assist with that medication today?
CMS-PRD1-095822 Universal Care - Consultative Call Flow (CCF) Process
Ida Knowl utilizes her Mail Order Pharmacy benefits. She has a new Rx for her doctor and would like to continue to use Fill & Bill. What should you check first?
If the Client allows Fill and Bill, it will display as an option in the Payment Method drop-down menu.
TSRC-PROD-064255 Aetna Compass - Obtaining a New Prescription (Rx) for the Member (New Rx Request)