Acronyms
What is AWP, Average Wholesale Price?
This is our Customer Relationship Management system where we look up our members and their medicines.
What is CRM?
For 2021, this stage of Medicare starts when the member's TROOP equals $6550.
What is catastrophic coverage?
This is the first information we get from the member, along with their name and policy number.
What is a callback number?
What is OMS/Epost?
This savings account is created at the beginning of the plan year and does NOT roll over at the end of the year.
What is a FSA, or Flexible Spending Account?
(versus an HSA, which you add to each pay period and it DOES roll-over)
Use this system to access Retail to Mail to send faxes to doctors. You can use the link on the side of the Med Tab in CRM.
What is Rx Connect Pro?
Use these two systems together to push through orders so they don't get stuck in consolidation.
What is CRM and OMS/Epost?
This is necessary to establish if you are talking to a third party and they don't have a POA or Consent Form on file.
What is implied consent?
Use the web registry link in this program to sign up a member that wanted to sign up to refill prescriptions online but didn't know how.
This is the acronym for the department that makes decisions on prior authorizations.
What is HCPR, Humana Clinical Pharmacy Review?
Use this system to change a member's email and phone number in the Humana system. You can access it on the side of the Med Tab using the Ci/Papi link.
What is HOD vendor?
These are 2 ways a member can get medicine early if they don't have enough to last until theirs arrives.
What is, Get samples from the doctor and fill a monthly script at the local pharmacy?
What is the Doctor's Information?
Use this system to perform a test claim to see if a member's refill order will go through, and the correct price for the claim.
What is RX Nova or Argus?
The acronym that tells you what to do with each call: HEAR.
What is Hear, Empathize, Acknowledge, and Resolve?
This is the invoice system that we use through CRM or the Hi! Page. It can send invoices by mail or by email.
What is EMME?
Use this when a member calls to refill an expired prescription, and notifies us that their doctor has changed from the original script.
What is Retail to Mail?
This is a necessary question whenever the member calls in for a refill or calls to check on their order. This is making sure we are taking care of the member
What is, Do you have enough medication to last until this arrives?
What is CRM and OMS/Epost?
This acronym is a federal law that restricts access to an individual's private medical information.
What is HIPAA, Health Insurance Portability and Accountability Act?
This system would be used if a member called in to find out prices and/or coverage details for a new prescription they haven't ever filled with us before.
These are 6 ways you can help a member if they say they can't afford their medicine. You can phone a friend for help.
What is, reduce the quantity of the supply? See if they qualify for a payment plan? See if they qualify for a LIS? See if they qualify through manufacturer assistance programs? Request a tier exception through HCPR? Cancel the high cost item so the lower cost items can still ship?
This statement is essential during a call because it lets our members know that they have more options than just calling us.
What is Self-Service promo?
You can open these 3 forms from the digbot toolbar.
What is OTC order form, Prior Authorization Form and Escalation Request?