Basics
How long do we have after the beep to answer?
5 Seconds
What is our daily enrollment average?
10
Where can we access our scripting?
- CCE
- Sharepoint
-Pulse/Quick Connect Mail
I can pick and choose when i want to follow CCE?
False. CCE Is required on every call.
What does 70 DNI mean? and Can we use it to provide pricing?
Means denied and No we cannot provide the price.
What info is needed to verify welltok?
What is our overall production rate?
50% or higher
Where can i go to view what the member paid previously for their medication ran under their Humana insurance?
Argus < View Claims
or
RxConnect > View Claims (if listed)
Where does the network disclaimer need to be read within the script?
-Before the absolute yes
What does code 526 mean in mentor document, Actions for RxNova Error Codes
Exceeds Max Allowed Fills
What type of transfer should we do with every department?
Warm Transfer
What is our ACW goal ?
120 seconds aka 2 minutes
Where can i go to price for 30 days on a typical 90 day medication?
Argus
if none
-Ask for the member to provide verbal. The mbr needs to provide their first last name/dob/zip/ and tell you that you have permission to speak with that 3rd party.
What is the phone number to the Humana At Home Dpt?
150-0100
1800-662-9508
What type of plans do we have?
MA (medical)
MAPD (medical + prescription)
PDP (prescription only)
What is our PTV goal?
2% or less
Where can i view the type of plan a member has?
Opening page of crm blue
Hovering over MED tab
Crm Blue > Details tab > Policies
What is the doctor verification hierarchy?
- if address is verified then SureScript
-OMS
- Calling docs office
When is the first reminder call sent to the members on a 90 day supply?
Sent at 72% utilization based on adjudication date.
(Mentor Doc : CWPCC Auto Refill Overview)
What verb is needed on every non enrollment call?
Closing Not Interested
What are the three individual LOB goals?
Inbound - 50% +
RTE - 55%+
Welltok 42.5%+
Where can i go to see if a member has LIS assistance?
CRM Blue > Med Tab > Eligibility Information
If a member has a MA plan only, what are they eligible for, and how can we process that item?
MA plans are only eligible for diabetic supplies and it needs to be prices through argus, Man Fax (go/manfax)
What information is needed within the notes to use the Accepted Enrollment document?
Requirements:
-Prescription Name
-TAT
-Method of how scripting is getting to us: escribe, fax, or mail in
-Price Estimates