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Benefits > OHI
In addition to offering and enrolling in Automatic Refills, where eligible, what should also be said/done to receive FULL POINTS for automatic refill education?
The education portion! Let them know to contact us if anything changes pertaining to the medication, in the event that the automatic refill selection needs to be changed.
No. You will actually lose points for asking on MEDD calls.
Where can the Extended Payment Program (EPP) be found?
EPP can be found when adding a credit card to the account underneath the "autopay" box.
SME Chat Question: I have a daughter-in-law on the line for a Tricare member who is in assisted living, and she wants to change her address. She is NOT listed as a caregiver. If I verify name, zip and DOB is it ok?
Yes, you fully authenticated the account with the full name, zip code, and DOB.
SUPRISE!
Are you able to share your screen right now? If the checklist is on your screen, Bree owes you 50 Cigna Standout Points.
Give us a good example of probe and pivoting.
N/A
Where can I find the stages for MEDD accounts?
View stages on the drug coverage screen either from the Prescription List when pricing a medication or from navigating to Benefits > Drug Coverage > Search Medication > Select Medication.
Where can you check to see if a member is eligible for web registration and enroll them as well?
SME Chat Question: Is it out of scope to cancel an order?
Yes, transfer to customer service.
Outside of mail order and the retail pharmacy, where is an additional option for Tricare members to fill their prescriptions?
MTF - Military Treatment Facility
If there is a previous balance on the account, or credit, that you observe when processing an order for a member, are you required to mention that?
Yes
If you have questions pertaining to your calls, what resources can you use to obtain the answers to your questions?
SME Chat/Evening Chat
Lead - Ro
Supervisor - Bree
Team Chat
Knowledge Exchange
Tips of the Day
Team Meeting Power points
When should the monitoring disclosure be provided on calls?
At the beginning of every OB call where the edialer pops up with the suggested scripting. You should also provide the monitoring disclosure whenever the phone switches to a new caller.
CSP Navigation: Where is the RTM Screen (conversion opportunities), Rx list (refills/renewals), and FFF sections CSP?
RTM Screen/Conversions - Prescription List > Home Delivery Opportunities
Rx List/Refills/Renewals - Orders > Order Now
FFF - Request Rx
Guess the Plan Design:
Patients must fill long-term Rx at home delivery.
Exclusive Home Delivery
SURPRISE!
SURPRISE!
Are you able to pull up today's quote of the day sent to the team from Bree today or 25 Cigna Standout Points?
If a member asks me to update their address on the account towards the beginning of a call, and I process a order later on in the call, are you required to repeat back the same address that you updated to the account early on?
Yes, this is a requirement, and if not completed, you will receive a QSO.
What is the difference between placing decisions on file for Smart 90-Active Choice accounts and Select Home Delivery Active-Choice accounts?
Smart 90 Active Choice - Patient Preferences
SHD-AC - HAP or Manually (Prior Authorization)
Guess the Plan Design:
Patients have the option to fill 3-month supplies of their long-term prescriptions at home delivery or at a specified retail pharmacy (For Cigna members at a specified Cigna retail pharmacy.) **Not all pharmacies are in the 3-month network. Patients are not required to use home delivery, but will see a cost-savings if they choose to do so.
Voluntary Smart 90
For a member that states that they are out of medication, or will be out of medication prior to receiving their order through, what should you say to avoid receiving a QSO?
> Offer a RPH (to go over side effects of not having the medication
> Recommend that they reach out to their doctor for a prescription to pick up a short-term supply a the retail pharmacy.
> Recommend that they pick up a short-term supply from the retail pharmacy.
For a renewal, what is the appropriate verification of a prescriber (QSO item)?
Full name
Full Address, City, State of Full phone number
(All three pieces as well are acceptable)
How do you provide 90-to-90 Cost Comparison for MEDD calls (QSO Item)?
> Pricing of medications must be done in drug coverage (allows you to view current stage here)
> Always provide the 90 to 90 cost comparison between retail and home delivery using maintenance or long-term CSP retail pharmacy.
What is the NEW MCC Notify Your Doctor verbiage? (Note: You will start being scored towards this in January)
"To make sure that you get your medication as soon as possible, it may be helpful to contact your doctor's office to let them know that we are sending over a request and that you now want to get this prescription from Express Scripts Pharmacy."