PC/PG/RCA/CAP
When should RCA via 5 why's for a PC be completed and documented in SFDC?
Within 3 days from PC closure
How often should we follow-up with BSC via case comments when they have not responded to questions or have not provided expected approvals?
every 24-48 hours at a minimum
What causes COA workflow work assignments to automatically generate and assign?
Appropriate labelling of of classification (CCO Clinical Benefits)
What system and query can be used to comprehensively find plans mapped to carriers/accounts/groups by BSC's eligibility?
EZQuery Sequel > QJCAGP
When is it appropriate to manually code something that would normally be coded via automation?
only if governance approval is granted, we have worked with automation and have a plan for automation to be updated for future builds, and all additional quality steps defined in CAPs are followed
When is the benefits team responsible for providing BSC with impact analysis?
PC cases
When can a client facing case be pended? (2)
If we have asked BSC a clarifying question and we are awaiting their response to move forward OR if we have delivered testing and are awaiting approval of testing
When is the last moment that I can alter a CCD on a case without being penalized for not meeting the initially committed CCD?
prior to closing out any work assignments
What FMS report will show you how each NDC will land based on the overall formulary structure indicated in the formulary shell and contents of all formulary drug lists?
Complete Formulary
How many times per year does GPI conversion occur?
2
Where do I find the PGs for various types of benefits work?
Teams > BSC > BSC SLA.pptx
What field in SFDC indicates that a case is client facing?
Portal case
When can the source type on a case be changed to one of the following and what would be the reasoning for each(Minor Request, Testing Only, Research)?
only when in add/change - once altered, cannot be switched while case is open. once case is closed, a sales support case is required to alter after the fact
What query can be used to comprehensively look at all lists coded in an MDL and some of their attributes?
QVSAMM
What document is maintained by our team that shows many important details such as formulary rules for all lines of business, carrier details, contact info for our team members?
Client Playbook
How often should you download a new/fresh copy of our BSC Research and Production Correction Policy & Procedure?
Right before you start working a new research/PC case - in case there are new updates
How often should case comments be provided to BSC on cases where we are not simply proceeding on schedule through regular coding and testing at the time (in research phase or when there are delays)?
every 24-48 hours at a minimum
What reports on the dashboard do we prefer to always see as empty (that we can control)? (5)
acknowledge w/i 24 h, missed TCD or TTCD, cases in ASR, open case CCD past, BSC cases in final review
What FMS report will show me history of all changes to a drug list and what case they were changed on (even things not currently active)?
Drug List Audit
Where can I find the most up to date list of contacts and role for BSC partners and also a listing of BSC holidays?
Engagement Activity Logs - link can be found on playbook
When must a CAP for a PC be delivered to BSC?
By the end of day 14 with PC creation date as day 1
When can/should a client facing case be closed?
only upon approval to close from BSC/when all benefits work is completed
What is the appropriate CCD change reason if we are at any stage in the case where we havent received BSC review and approval of testing?
awaiting client approval
What must be done before cancelling a case and/or having a bar pulled?
verify no coding on the bar via rxclaim bar admin. If FMS coding, must follow FMS procedures related to bar rollback + standard RM bar rollback process.
What are the last 2 views on the dashboard that should be checked before finishing your workday?
CCD/TCD/TTCD Today + Next 2 days for cases as today(should be none), pended cases with comments(find any needing unpended and send to RM)