TO CHASE OR NOT TO CHASE
Cases should not be assigned to Chase when member is using this type of pharmacy.
What is AHD/Carelonrx, or pill pack service
A member requests a 90 day supply, but only 30 day supply remain at the pharmacy. The initial associate should not do this.
What is fill 30 day supply?
You see a yellow sticky note that indicates the provider will only accept refill requests from member, what should you do while you're still on the phone with member.
What is ask the member if they would like you to conference in the provider office so the member can request refill? Or ask the member if they can contact the provider to request the refill
Who is the provider?
These future fills should not be assigned to Chase.
What is 90 day supply future fills?
If member wants to begin using Carelonrx for future fills, what should you ask the member in order to prevent a gap in medication fills. (keeping in mind a new AHD referral process can take a week to 10 days to 2 weeks)
What is, would you like me to get 1 last fill at your local pharmacy so you don't run out of your medication.?
Before reassigning a case to Chase, review previous Chase assessments and these notes to avoid duplicate outreach.
What are Public View Yellow Sticky Notes?
Before assigning a case with a new provider, ask whether the member has completed this.
What is the first appointment /established care with the new provider?
If the member requests a refill from a different provider than the one that wrote the original prescription, what should you ask the member to avoid delay in obaining paid claim.
What is ask the member if they have discussed the medication with the new provider?
If the member tells you they have an appointment with the provider scheduled for a specific date, where should you document that information.
What is on the notes to chase section and/or on your questionnaire?
Before asking Member's new pharmacy to transfer a prescription from the old pharmacy, the initial associate should do this first to confirm active refills remain
What is review members prescription history/prescription information tab in COS/M360?
If the pharmacy indicates they will refill medication on a specific date, where should this information be documented for the Chase team
What is in the "notes to chase" field on the chase submission form?
If the provider phone number you verified with the member is a hospital (hospitalist providers do not authorize refills) what is a question you should ask the member in order to prevent duplicate outreach.
What is do you see this provider at a different facility? OR, Who is the provider that normally writes for this target medication?