Tracker
In awaiting shipment how many days do we give an order to ship (currently in progress)?
Two days
Who can work priority Orders?
Everyone can work priority orders not in resync or new therapy.
What medications not eligible to go to New Therapy?
Anything that's OTC, Controls, Diabetic supplies, and less than 90-day supplies.
How many times do you have to say the members name during a call?
At least twice
What does REV in argus mean?
That the claim has been reversed.
What should be updated in the tracker when an appointment is a No Show and member has a tracker profile?
Enrollment status (opt out), Work date (blank), Action taken (opt out) Destination queue (blank)
How do you see all orders in MSHQ instead of just the top 50?
Drop down to available items
When moving a member to resync or new therapy what should we do to the order status?
Make sure to prioritize the order and adding to the tracker note at the top.
What is required for authentication on OB calls?
Identify if you are speaking with member directly, verifying DOB, inform you are on a recorded line.
When placing an order on hold with paid claims what needs to be done?
Reverse any paid claims.
What does it mean when a member is in the refill queue?
The member has opted to not enroll in auto refill. We call the member for approval on the first sync order. Then it moves to completed queue for member to manage own fills.
After changing sync status to No what do we need to look out for?
That the Med Sync banner stays on
If a new med comes in not on tracker, but still filling with the rest of synch meds, does it need to go to New therapy?
No, if still filling with the rest of meds, just send it out and add to tracker with Yes for Synch and ARF
When RxE provides member info (name, Hid), what needs to be asked before taking over call?
Has member been fully authenticated and verified?
What makes a member eligible for Med Sync?
When enrolling a member where should we be adding the medications from?
RXE note and Epost medication list.
How many orders are to be worked per hour?
12 minimum
Member receives new rx for B-12 Needles. Eligible to be filled today. Next fill date for other meds is in 30 days. Would you send to new therapy?
No not eligible for sync
When speaking with member and third party takes over call, what should be done?
Identify third party name, check for POA/ COF, introduce yourself- if no POA/COF, obtain verbal/ implied consent.
Where do you check if you don't see an RXE note in epost for a member?
CRM case history, New rx request, Rx connect under RTM tab
What does it mean when there is no requested date in tracker for a med?
Med was already on file with refills before synching - no Rx request needed.
Who can work Mississippi members?
Only Arizona and Ohio Techs and RPH
If new medication comes in not in tracker and not prechecked, does it still go to New Therapy?
Yes, add medication to tracker and send to New Therapy
When a member asks what a medication is used for, and you know the answer are you allowed to tell the member?
No, you must consult a RPH if indication is not listed on prescription directions.
When working an epost order and you notice a high copay what should you do?
Make sure it is adjudicated properly. If it was processed correctly allow to go to finance queue. If member denies copay at that point remove from sync.