IW IS INTERESTED IN HD
WHAT DO YOU DO IF Injured Party provided an email address
Update the provided email on the Claimant Tab.
The file is Terminated what are the first 3 things you do?
A. Document the file and call codes.
B. Place your initials in the Associate drop-down box.
C. Change the Status to Closed.
What MRS codes are frequently used?
RSH
Did you speak with the attorney and were UNABLE to obtain a decision if you can call the injured party?
IF YOUR ANSWER IS YES WHAT DO YOU DO? NAME AT LEAST 3 STEPS
1. Place your initials in the Associate drop down box.
2. Change the Status to Closed.
3. Change the outcome code to Exhausted Efforts.
Note: To see a list of all Outcome Codes, proceed to Outcome Code section of the Documentation SOP - HD Recruitment.
4. Click Save and then Close.
5. Update the end result for the referral on the Productivity Log - HD Recruitment accordingly.
If working a Rush Referral, continue to Rush a Referral, (Providing Rush Referral Outcome) section.
WHAT IS THE FIRST TWO THINGS YOU DO IF HD WAS ORDERED IN THE LAST 6 MONTHS?
a. Document the file and call codes. DFC, <reason (terminated or AR Prohibited)> per UniVerse. <extension>
b. Place your initials in the associate drop down box.
Injured Party stated, advise Non-Eligible Medication Scripting
A. "At this time, your Insurance Carrier is not authorizing that/those medication(s) through Home Delivery."
What do you do if The injured party answers?
“Hello, this is <your name> calling from Optum. We are the Pharmacy Benefits Manager for <carrier name>. For training and quality purposes this call may be recorded." May I please speak with <injured party’s name>?”
What does CBS mean
Client Business Service--In house sales associate
if this was your first attempt to call the attorney what do you do?
1. Select a Follow-Up Date in MRS: Set a Follow Up for no sooner than two business days.
2. Update the end result for the referral on the Productivity Log - HD Recruitment accordingly.
WHAT YOU MAKE AN OUTBOUND CALL AND THE INJURED PARTY ANSWERS WHAT DO YOU SAY?
“Hello, this is <your name> calling from Optum. We are the Pharmacy Benefits Manager for <carrier name>. For training and quality purposes this call may be recorded. May I please speak with <Injured Party’s full name>?
IF THE IW IS Not interested NAME THE FIRST TWO THINGS YOU DO
A. Document the file and call codes.
PT RS <refusal reason>. <extension>
B. Place your initials in the associate drop down box.
Able to verify PHI what do you need to ask for?
What do you do if its your second attempt to contact the attorney?
1. Complete the Attorney Letter.
2. Send the letter to a HDPSups email.
What is your scripting if the insurance carrier is ESIS?
“Hello, this is <your name> calling from the ESIS Pharmacy Impact Home Delivery program. We are the Pharmacy Benefits Manager for ESIS. For training and quality purposes this call may be recorded. May I please speak with <Injured Party's full name>?"
WHAT SHOULD YOUR HIPAA NOTE INCLUDE?
HIPAA Authorization Note - 4/23/15.
Auth from: PT
Authorization to Use and Disclose Protected Health Information
Wife/Karen Flintstone and attorney Mike Brown.
Permission to leave detailed VM 555-222-5555 <extension>
What are at least two reasons an IW may refuse to verify PHI
- Do not trust mail pharmacy.
- Do not trust post office.
- No reason – don’t care.
- Prescriber doesn’t want mail.
- Prescriber dispenses medications.
- Preferred Retail Pharmacy
- Other
What does PIP mean?
Auto Accident Client
What is your subject line of your email if you did not reach the attorney and its not the first attempt/
Attorney Letter
WHAT DO YOU NEED TO VERIFY FOR PHI?
Explain the Automated System.
“Once you receive your first order, the pharmacy will contact you when you are down to approximately 16 days' supply. They must hear from you in order for the medications to be refilled as they cannot fill them without your authorization.”
What does you note say if the IW is not on medications
WHAT DOES THE CODE Initial Call mean in MRS?
Status used when assigning referral to associate
WHAT NEEDS TO BE INCLUDED IN YOUR EMAIL TO THE ATTORNEY IF YOU WERE NOT ABLE TO REACH THEM?
Injured Party’s full name
Name
Date of injury
Encrypted ID #
WAS THIS THE MOST FUN TEAM MEETING WE HAVE HAD?
YES OF COURSE!!!!!