Which One?
What are the 3 medications handled by CoverMyMeds?
What is
Ogrovyx
Nuedexta
Synagis
If you ask for the copay or coinsurance for a 90/30 day supply of the medication Orgavyx and rep adv 840.63. Do you take the answer or headset?
What is
NEITHER, you must push back with "That sounds like an estimate, can you provide me with the percentage?"
How many times will we try on a covermymeds call as EVA before we fail it?
What is
2 Times
What push back do we use if rep does not understand the question?
What tier is _________?
What is
There is no push back. Headset and continue.
If you have to disconnect for any reason other than what is on the "Process Task Feature" document then what will you select for the incomplete reason?
What is........Other - Specify in Notes
Which medication under Covermymeds is BOTH PBM and MM?
What is
Synagis
Is there a push back if the representative advises the member is on LIS (Low Income Subsidy) Level 3?
What is
Yes "I understand that this is a low income subsidy plan, and therefore not subject to the initial coverage limit. Can you answer my remaining questions?"
Optum RX is for UHC PBM calls. Who do we call for UHC MM AND PBM calls?
What is
Optum Rx is ONLY UHC PBM calls. UHC MM+PBM should default to provider service line
MENTAL AGE TEST
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If provider is listed as in network at a different address can we use the NPI Record tool to see if address is listed?
(Lucentis)
What is.....Reminder on Lucentis we are not able to provide an address from the NPI record. Ultimately if they are in network at a different address we have to collect in AND out of network benefits per line 20 of Q&A
Which medication under CoverMyMeds is now eligible for human calls if they wont talk to Eva?
What is...
NONE- we do not do human calls for ANY of the CoverMyMeds medications
Are You Right Or Left Brain Dominance ? Personality Test
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If an agent disconnects the call at the start of Eva's greeting on a CMM call, how should we process the task?
What is
Agent Refusal x1
Are there any quantity limitations?
30 in 30 Days
Do you input 30 days or headset
What is
Select 30 Days
You call on a Cigna Medicare Advantage(800-668-3813) account (U5846795846) and they are unable to locate account. What incomplete reason will you select?
What is .......Need to call different phone number??
In this example the id starts with a "U" and according to "Identifying Insurances" "U" IDs are Cigna Commercial and we must call : 800-244-6224.
For certain payers where if the agent is unable to locate an active member plan, SOP is to make another call to a different number first (e.g., general blue card line for BC plans) before failing.
Which CMM Medication has a 6hr turnaround time?
What is
Synagis
Is it okay to have two different amounts in the "How much has been accumulated toward the initial coverage limit?" AND "How much has been accumulated toward the true out of pocket?"
What is
Yes, it is okay to have separate amounts
What PB do we use when an auth is expired or future dates?
What is
Is there an active one?
If you ask is the medication covered at retail or mail order and they say no to mail order. Do you have to push back or do you just input no since they said yes to retail?
What is
PUSH BACK- Even if one of them is yes because we must push back with "Why is the drug not covered?"
If an agent gives an abnormal coinsurance like 18% or 19% do you take it as is or should you push back? What is the correct push back IF NEEDED?
(Lucentis/GRAS)
What is......"Can you check that, please? That coinsurance amount normally applies to Durable Medical Equipment."
Line 138 Q&A
What unique question is listed in the Synagis "Access Information" Tab that is not on the other two medications?
What is
Coverage season/date for PA submission question
Prime Theraputics will only answer what 7 questions?
What is
Plan active?
Prior authorization required?
Is prior authorization on file?
Ask related PA questions, IF authorization is on file.
How to obtain prior authorization?
Preferred specialty pharmacy?
Commercial/Govt plan?
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What is the default SP for Anthem of BCBS plans?
What is
IngenioRx
If provider is out of network and the practice is also out of network do we collect only out of network benefits if available? What do you do if out of network is not available? (2 part question)
(Lucentis/GRAS)
What is ......NO; you must ALWAYS attempt to still collect both in and out of network benefits and if they refuse to give in network then you will proceed with out of network only. Also if member has NO out of network benefits we still attempt to collect in network and if they refuse then gracefully exit.
Line 29 Q&A