- CSR did pre-order call to a customer from Pennsylvania but no eligibility done yet. Elig team just need to do eligibility to PAMA website, then if eligibility is ok, no changes with consumer’s insurance from PAMA website to our Manual Certify Eligibility table- NEW FO- READY
- Pre-order Call and eligibility were not completed. CSR should call consumer for POC and do eligibility if necessary. If not, CSR will put FO note POC done, Elig team just need to do eligibility to PAMA website, then if eligibility is ok, no changes with consumer’s insurance from PAMA website to our Manual Certify Eligibility table- NEW FO- READY
- if consumer’s is from out of state, CSR will do Pre-order call then FO note is POCOK/ELIGNEED.
- CSRs used this FO for out of state consumers. This is code for CSRs that will help identify if the customer’s is out of state. The status is : Pre-Order Call was done, anyone who has access to check eligibility for out of state consumer will run eligibility. If everything is correct 1. Medicaid Active 2. MCO is PAR (if avail) 3. All insurances available on Manual Certify Eligibility table and medicaid website. Put notes and change FO NOTE to READY
*** OUT OF STATE CONSUMERS ELIGIBILITY SHOULD BE CHECKED 3-5 days before printers will shipped out order****
FO, FOIN, FOFXIN
- Printers should make sure that FO Note will be deleted if necessary.
- If after printing, CSR needs to do RX FU/ SO FU or any follow ups for consumer aqfter order please make sure to put in FO the necessary FO NOTE.
RX FU / NEED RX / RX REFAX
- Consumers prescription is expired or needs an increase. We need to receive the prescription first before we proceed on eligibility and pre orde call.
SEND AS IS / SEND (date)
- Consumer is willing to wait for the updated prescription and if not receive in time (date the order is about ot go out, order will be send as is). What we have for consumer’s normal order, send it. For printers, make suere that eligibility was done. Then after printing, put RX/FU so CSRs will know that it’s for RX.
- Means consumer is not in need for order. Usually consumer wanted to skip for this month or until how many months. No need to certify the eligibility. No need to change the FO NOTE.
If FO NOTE is AOB FU / AOB IN / NEEDS AOB
- AOB or Authorization of Benefits is a document signed by a policyholder that allows a third party to “stand in the shoes” of the insured and seek direct payment from the insurance company. In regards with new consumers, first order can be sent even without the AOB, but on the next bacth of orders AOB should be present and already signed y the cosnsumer. You can Run and verify eligibility on its respective state, create CSR notes and no need to change the FO NOTE
If You Encounter NO CONTACT consumers
- If a consumer has not been contacted for 3 consecutive months, and when CSR team keeps on getting voicemails during pre order calls, FO NOTE turns to NO CONTACT. CSR team will hold the order until they spoke to a live person. It can be their emergency contact person, friend or a family member.
- If a consumer was contacted on the previous month- for the next 3 months, (if numbers on file are WORKING & ABLE TO LEAVE VM, UNCONTACTED, JUST RINGING, NO OPTION TO LEAVE VM, MAILBOX IS FULL, PHONE NUMBER DISCONNECTED ) Run and verify eligibility on its respective state, create CSR notes and change the FO NOTE to READY.
If You Encounter Deceased
- If deceased, put consumer on hold code 3, term the insurances to the DOD, which can be found on Medicare usually or the date someone tells you. If you don’t have the date put the date you found out. Put a note in the main notes and FO note section, Have Tamekha pull the folder. If there is already an order sent to the warehouse make sure you get it pulled. If there is an RX in the RX request list make sure you delete it.
- as per Sandy, they should be checked once a week for the first month then monthly after that. After a year if still ineligible put on N and have folder pulled. Term the insurance date for the right insurance.