Process Calls
This is the rarest process call option.
What is "other"?
This plan type is reserved for military active duty, veterans, and their dependents.
What is Tricare?
The pushback used when an agent states they cannot continue the call on a recorded line.
What is, "No problem, I have stopped recording."?
L.I.S is the acronym for this program that helps people with limited income and resources pay for prescription drugs under Medicare Part D.
What is Low Income Subsidy?
The acronym SOP, is short for this document that is frequently used by operators for questions and answers, as well as product information.
What is the Standard Operating Procedure?
This is the process task used when an agent transfers us to the Specialty Pharmacy.
What is 'agent transferred call to the incorrect department'?
This insurance plan applies to patients 65 years and older.
What is Medicare?
This pushback is prompted when the agent states there is no copay and no coinsurance for the medication.
What is, "So the plan pays 100%?"
This is the amount of levels under LIS.
What is four?
This is the information we input if a reference number is not available.
What is the agent's first name, last name initial, and date?
This is the process task tab used when the client enters inaccurate data into the platform and the agent is unable to continue the call.
What is incorrect input information?
This is the question we ask to determine who will pay first when there are two or more health insurance plans.
What is other insurance?
This pushback is used when an agent states there is no speciality pharmacy for the drug to be obtained.
What is how does the patient get their specialty medication?
This is the coinsurance percentage covered in the gap phase for a standard Medicare plan.
What is 25%?
The number of ways to obtain PA we need to collect.
What is one?
This is the process option for hold times of 30 minutes or more.
What is payer not reachable?
This plan type is a joint federal and state program.
What is Medicaid?
These are the steps taken when an agent states a drug cannot be covered with a prior authorization and requires an appeal.
What is mark the drug as not covered and gracefully exit the call?
This is the coinsurance percentage in the catastrophic phase for a standard Medicare plan.
What is 5%?
Located under this tab, is where Eva can prompt her last name initial. BONUS: This is Eva's last name.
What is the Greeting & Answers tab? BONUS: What is Lightyear?
TPA is the acronym for the entity that provides and delivers different administrative services on behalf of a specific insurance plan.
What is a Third Party Admininstrator?
This is how we proceed when an agent states they can't provide benefits because the plan we are calling is secondary.
What is mark the drug as not covered and gracefully exit?
When a prior authorization is pending, this is the pushback that is prompted.
What is no pushback, enter pending and continue?
This is another term used for the coverage gap phase of Medicare.
What is Donut Hole?
The prompt in plan design, "is there a monthly spend down and how much has been spent?" is specific to this healthcare plan.
What is Medicaid?