QA Guide - Single Page

Opening

Prescriptions & Pharmacy

Plan Presentation

Enrollment

Opening

Greeting Landing Page:

Introduction:

• Branding

• First and Last Name of Agent

• Agent licensure acknowledgement

• Customer First and Last Name

• Member verification

• Member ID

• Address

• Zip Code

• DOB

• Phone Number

 If you are going to present a plan, Go to “Unsure of Plan/Switch Plan:”

Eligibility Landing Page:

Remind agent to ask Medicaid/LIS questions

The following Disclaimer must be read:

 The following scripting must be read:

• Verify Employer or Union health coverage

• Verify part A and B eligibility

• Verify if the caller has Medicaid

• Verify if the caller has Extra Help
  

If you already know the member’s enrollment period, simply restate it for the recording. If you have not yet identified an enrollment period, you must read this section:

Complete the Needs Analysis section

Prescriptions & Pharmacy

Start by creating a new Profile by clicking “New beneficiary”

Verify and accurately enter the following:

• Zip Code

• First and Last Name

• County

If you have obtained the following, please also enter:

• DOB

• Phone Number

• Home address
  

Scroll to the bottom and click “Continue to Plans:”

On the left side of the screen, click the “Preferences” dropdown, followed by “Add Preferences:”

Select the “Prescriptions” tab and search for each medication:

The following items must be verified when gathering medications:

• Name of Rx (Example: Lisinopril or Lisinopril/HCTZ)

• Dosage Type (Example: Capsule or Tablet, 5mg or 10 mg)

• Quantity (Example: 30/60/90…It is recommended to use 30 days)

• Frequency (Example: per month, etc)

If there is a generic option, you MUST ask the following:

Pharmacy

Verify the member's pharmacy:

Part B buy-down selection under “Other Preferences” is optional unless requested by the member:

Plan Presentation

Review plan details for the most cost effective plan by clicking “Plan details:”

MAPD Call Requirements:

MAPD Plans

The following must be verified on EVERY call:

1. Plan name and premium [Extra Help/Medicaid: Should be quoted from the LIS table and original premium of the plan]

2. Medical deductible

3. PCP & Specialist Copays

4. ER and inpatient hospital copays

5. Dental, Vision, and Hearing (if applicable)

6. Identify 1 PCP and at least offer to look up Specialist and Hospital networks
   

   

7. Pharmacy Deductible [Extra Help/Medicaid: Should be quoted from the LIS table and original deductible of the plan]

8. List at least 1 Preferred Pharmacy. If you originally selected a Standard Pharmacy click the “Pharmacy Directory” link to find a Preferred Pharmacy:
   

   

9. State that the mail order pharmacy is CVS Caremark

10. OPTION 1: Prescription Copays (You must quote preferred pharmacy pricing. If the member would like to use standard or mail order pharmacies, you may quote that as well).

    1. State copays applicable to member’s drugs [Example: “Your Metformin is a tier 1 Rx with a $__ copay. Your Eliquis is a tier 3 Rx with __% Coinsurance.”

    2. State copay amounts for each tier [Example: Tier 1 drugs have a $___ copay; Tier 2 drugs have a $ __ copay; etc] This must be stated when members say they do not currently have any prescriptions.

    3. State whether each tier applies to the deductible [Example: The deductible for this plan applies to tiers 3, 4, and 5. Some of your drugs are tier 3, so the deductible will apply to those drugs”]

    4. Quote drug phases that are projected to apply to the caller. To Identify copays for the various phases (Coverage gap/Catastrophic coverage) the agent shoud go to the Total Costs Tab at the top.

11. OPTION 2: State copays/coinsurances for each tier.
    You must state pricing per tier, even if the member currently has no prescriptions.
    You must quote preferred pharmacy pricing. If the member would like to use standard or mail order pharmacies, you may quote that as well).

    1. Tier 1 are your preferred generics which have a $__copay. The deductible does/does not apply. The following drugs are tier 1: [name all applicable medications and costs].

    2. Tier 2 are your generics which have a $__copay. The deductible does/does not apply. The following drugs are tier 2: [name all applicable medications and costs].

    3. Tier 3 are your preferred brand name drugs which have a __% coinsurance. The deductible does/does not apply. The following drugs are tier 3: [name all applicable medications and costs].

    4. Tier 4 are your non-preferred brand name drugs which have a __% coinsurance. The deductible does/does not apply. The following drugs are tier 4: [name all applicable medications and costs].

    5. Tier 5 are your specialty drugs which have a __% coinsurance. The deductible does/does not apply. The following drugs are tier 5: [name all applicable medications and costs].

1. State applicable drug restrictions for each medication [ie: Quantity Limits, Step Therapy, and Physician Authorization]

PDP Plans

The following must be verified on EVERY call.

1. Plan name and premium [Extra Help/Medicaid: Should be quoted from the LIS table and original premium of the plan]

2. Pharmacy Deductible [Extra Help/Medicaid: Should be quoted from the LIS table]

3. List at least 1 Preferred Pharmacy. If you originally selected a Standard Pharmacy click the Pharmacy Directory link to find a Preferred Pharmacy:
   

   

4. State that the mail order pharmacy is CVS Caremark

5. Prescription Copays

   1. State copays for each tier [Example: Tier 1 drugs have a $___ copay; Tier 2 drugs have a $ __ copay; etc] This must be stated regardless of whether the member currently has any prescriptions

   2. State whether the tier applies to the deductible [Example: The deductible for this plan applies to tiers 3, 4, and 5. Some of your drugs are tier 3 so the deductible will apply to those drugs”]

   3. Quote drug phases that are projected to apply to the caller (To Identify copays for the various phases (Coverage gap/Catastrophic coverage) the caller will go to the Total Costs Tab at the top)
      

      

6. State applicable drug restrictions for each medication [ie: Quantity Limits, Step Therapy, and Physician Authorization]
   

   

Closing the Sale

Remember to ask for the sale

If Yes:

• Move to Enrollment section - send the quick quote and read the following email disclaimer:

  • "Providing an email address authorizes us to contact you via email. Your email address will be handled consistent with our Privacy Policy, which you can find on our website at www.aetnamedicare.com”

• Inform caller they will get 2 emails (check SPAM folders)

• Proceed to the Enrollment Checklist Tab in Contact Center

If No:

• Go back to Contact Center - Follow the “Offer Tree Landing Page” instructions to send an ekit or paperkit

Enrollment

Enrollment_1 Landing Page:

Enrollment Checklist Tab

• Read all mandatory verbiage verbatim - TE Checklist

• Have member gather the Medicare card and read the card verbatim: First Name, Last Name, Middle Initial, Medicare Number, Effective Dates of Part A and Part B

• Confirm if they are calling for themselves or someone else

• Reverify the caller information
  

Enrollment_2 Landing Page:

• Enter plan Contract number and PBP numbers (located in CNRX after the name of the plan selected)

• ReVerify information (don’t forget to verify whether they have Employer or Union health coverage)

• Select the type of MA plan:

CNRX Application:

Select “Add to Cart”

Section 1: Contact Info

• Restate the enrollment period to the caller (add date if applicable)

• Restate the requested Effective Date

• Restate member information

  • First Name and Last Name, Middle Initial

  • DOB

  • Gender (Example: For the recording, can you state your gender?)

  • Phone Number

  • Email (If you read the disclaimer already, you DO NOT have to reread this disclaimer)

  • Address Including city, state, and zip

  • Additional Mailing address including city, state, and zip
    

• Physician Selection

  • Primary Care Name

  • Confirm if they are an existing patient

Selection 2: Benefit Info Tab

• Read the following verbatim:

  • “Some individuals may have additional prescription drug coverage, including other private insurance, TRICARE, Federal Employee Health Benefits, VA benefits, or State Pharmaceutical Assistance.”

  • “Would you prefer your documents in a language other than English?”

  • Read and Answer all Yes/No questions verbatim

Section 3- Other Info

• Phonetically reverify the Medicare Number

• Reverify Part A and B effective dates

• Read all disclaimer verbiage verbatim in green:

  • Social Security

  • Extra Help

• You MUST offer all 3 payment options. Select payment option and read the bullets verbatim in that section:

  • You can pay by automatic withdrawal from your Social Security or Railroad Retirement Board Benefits check

  • You can choose automatic deduction from your checking account

  • You can pay by mail (Choose this option if the plan has a $0 monthly premium)

Section 4 -Agent Info

DO NOT READ, Select Yes, “You agree to the above statements”

Section 5 - Review & Submit

• Read the verbiage in green verbatim and click on the dropdowns for: Personal Information, Important Questions and Medicare Information

  • Read these sections non-stop and ask caller to stop you if anything is incorrect, use phonetics if necessary

Enrollment_2 Landing Page

• Play the audio disclaimer

• Read this disclaimer

• Verify who is completing the enrollment

• Read the “What to expect” Section

• Provide the caller the confirmation number and have them repeat it back

  • Copy the Confirmation number

• Read this statement:

• Read this section:

• Paste the confirmation number

• Closing: