Quality Sub Categories
Must be read verbatim
Clinical Questions
Where all users go to for their daily assigned work.
What is a Task ?
Is needed for the drug to be covered under the plan.
What is a Prior Authorization?
These messages provide important information about the patient’s medication and health updates.
What is IMM (Important Medication Messages)?
Proper Greeting , Call Summary, Proper Closing
What is Greeting , Closing, and Verification?
When the caller expresses a significant life event - either happy or sad – we are expected to acknowledge the life event (marriage, death in the family, birth) through words and tone.
What is empathy.
Diversions in which the MD will be contacted to schedule and/or reschedule an order
What is Production ? What is Scheduling Exceptions ?
The prescription serial number is invalid or missing.
What is a ECS Rejection?
Manually generated message sent via email to patient containing a link that allows the patient to ‘quick register’ for online access. Online access gives them the ability to refill prescriptions, pay a balance, access Secure Messaging, and track order status.
What is Quick Registration?
Educates on Appropriate Programs Options
What is Be Knowledgeable ?
All colleagues should provide a positive, hassle-free customer service experience to the caller that promotes confidence and builds good will.
What is caller experience?
Tasks in which we need to contact the patient (e.g., Refill Reminders, Counseling Requests, etc.).
What is Patient Engagement?
The drug has been previously filled within the maximum allowed timeframe of the utilization limit. The patient is refilling earlier than they need the product.
What is Refill Too Soon
Identifies if the patient has registered online
What is a Digital Profile ?
Use of Correct Template
What is Be Solution Oriented ?
Responds to what the caller is asking,
Ask questions and stays engaged to build rapport and show interest
What is Actively Listen and Respond ?
Patients identification number in the system
What is an account number ?
The patient is no longer covered by the prescription plan.
What is Coverage Termed?
These messages alert the patient that they have a prescription available for refill
What is Ready for Refill ?
Courteous and Professional Tone
What is be Compassionate?
Agent discloses HIPAA to an individual who is not entitled to that information. For example volunteering the name of a medication to the spouse.
What is a HIPAA Violation?
User-entered note with patient-critical information for other users.
What is a priority comment?
The high cost of the product requires an override and/or a PRIOR AUTHORIZATION for coverage.
What is Cost Exceeds Maximum ?
Used to assign patient’s preference of communication (Email and/or text messages).
What is Patient Contact Preferences?
Clarify, Probe, and Paraphrase when needed
What is Be Dedicated?