Overrides
Quality
Call Documentation
MyRx
Team
100
The amount under Approved Pharmacy Reimbursement is used for?
What is Claim $ Amount Override?
100
Thanks you (Pharmacist name)
What is Caller's Name?
100
Any Prior Authorization related inquiry, including, but not limited to Member or pharmacy calling to check status of PA or member calling to submit a PA request.
What is Prior Authorization Inquiry?
100
When submitting an override for a commercial plan i must use this?
What is Formulary Status for Commercial Plans Job Aid?
100
"What? What? What?"
What is Lucerito favorite quote?
200
Max 2 fills at retail?
What is MSMS?
200
Thank you for calling OptumRX.
What is Greeting?
200
Any general inquiries on member benefits, including TrOOP, MOOP, or Benefit Max.
What is Benefit Inquiry?
200
The drug is too soon to refill based on planbenefits.
What is Rejection79/88?
200
"Ohhh Jijiji"
What is Sarah's favorite laugh?
300
Medication is rejecting 70, 75, or 76
What is Pega Tool?
300
15 seconds
What is Unannounced Silence?
300
Pharmacy calls regarding checks and payment.
What is Pharmacy Inquiry?
300
Test Strips &/or Lancets rejecting 88
What is MAPD Part B Product Refill To Soon?
300
Oh i wasn't in that meeting?
What is Carlton's favorite quote?
400
If the drug status is: y or Y Form; Non-formulary w/msg
What is Commercial Formulary Status?
400
Communication, caller name usage, acknowledgement and clarification of caller’s issue, positive interaction, credibility and confidence, call control
What is Customer Advocacy?
400
In order to track the calls received, a drop-down menu has been created.
What is Call Type?
400
This must always be used to complete your Part D override.
What is Part D Override Job Aid?
400
outdoor activites and concerts
What is Karen's hobby?
500
This process allows part D members to receive temporary fills of medications that are not generally covered by the plan whenever they go through an unplanned transition.
What is Transitional Override?
500
Advocate will follow system-oriented standard operating procedures as found in company resources.
What is Process Accuracy?
500
Advocate will document the resolution to all inquiries pertaining to the issue(s) of the call plus any other information as required per company processes
What is Call Documentation?
500
Claim $ amount exceeds on a Specialty medication.
What is Specialty Medication Override Job Aid?
500
Reading
What is Alex's hobby?