DER SPIEL

JUST TO INFORM YOU WE HAVE 3

OPTIONS FOR YOU TO HAVE THE
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jqUd3H85lQ21IPheYOwZRzVQFORM.FIR
ST WE CAN SEND THE FORM
DIRECTLY TO YOUR OFFICE VIA
FAX.YOU CAN ALSO DOWNLOD THE
FORM TO OUR WEBSITE
WWW.WELLCARE .COM AND LASTLY
YOU CAN ALSO CHOOSE IVR.

OVER THE PHONE SPIEL

OVER THE PHONE AUTHORIZATIN
MAY PROLONGED THE PROCESS
BECAUSE IT NEEDS CLINICAL AND
MEDICAL NOTES SO WE HIGHLY
SUGGESTTO SEND IT VIA FAX.
LOST OVERRIDE SPIEL
CENTENE ARE NOT RESPONSIBLE FOR
LOST, SPILLED, DAMAGE OR STOLEN
MEDICATION. WE CANNOT PROVIDE
ADDITIONAL OVERRIDES, BUT WE
WILL ALLOW ONLY ONE REQUEST
PER ROLLING CALENDAR YEAR. IF IT
HAPPEN AGAIN, MEMBER HAS OPTION
TO PAY OUT OF POCKET.

VACATION OVERRIDE SPIEL

CENTENE CAN PROVIDE UPTO 2
VACATION OVERRIDE REQUEST PER
ROLLING CALENDAR.
RECORDING SPIEL
WE DO NOT ALLOW TAPPING OR
RECORDING OF CALLS, HOWEVER IF
YOU DON’T HAVE WAY TO TURN IT
OFF I CAN STILL ASSIST YOU.

GHOST SPIEL
CALLER I CAN NOT HEAR YOU, IF YOU
CAN HEAR ME, PLEASE CALL US
BACK. I AM DISCONNECTING THIS
CALL DUE TO NO RESPONSE. (3 TIMES)

JCODE TIME FRAME

STANDARD 72 HRS
EXPEDITED 24 HRS
ESCALATION/REWORK
48 TO 72 HRS
CROSSOVER SPIEL
THE REASON WHY IT COST HIGH
BECAUSE IT CROSS OVER BETWEEN
THE DEDUCTIBLE AND ICL STAGE
(DRUG SPEND) BUT DON’T WORRY
SINCE YOU ALREADY ACCUMULATED
DEDUCTIBLE YOUR COPAY NEXT
TIME WILL BE LESS.

TURN AROUND TIME

PA TIME FRAME
STANDARD 72 HRS
EXPEDITED 24 HRS

APPEAL TIME
STANDARD TIME 7 DAYS
EXPEDITED 72 HRS

WORK AROUND FOR OVERRIDE

OVERIDE TYPE:
ID #
DRUG NAME:
DRUG COST:
REJ
CODE
MONY

COPAY
VIEW CLAIMS- RX NUMBER (PAID
CLAIMS)- PRICING TRANSACTION-
MEDICARE PART D.
PAG FLIP SA COB
MANAGE ELIGIBILITY- MANAGE
ALTERNATE INSURANCE- CLICK
DATE- FLIP Y TO N.
PA CHECK ON COS
VIEW CLAIMS- RX CASE (PAID
CLAIMS)- RUN TEST CLAIM- OPEN UNG
DRUGS- MAKIKITA MO KUNG MAY PA.
COPY MO UNG PA NUMBER PASTE SA
COMPASS TAB WAG LAGYAN NG DATE
TAPOS ENTER MAKIKITA MO KUNG
KAILAN APPROVE NG PA.

ICHECHECK PAG LTC

PATIENT RESIDENCE 3 & 9
PHARMACY TYPE SERVICE 5
VIEW CLAIMS- RX CASE #- (DROP
DOWN BUTTON) PHARMACY
TRANSACTION- ADDITIONAL
PATUENT INSURANCE.

PAG ANG CONCERN IS KUNG

COVERED BA ANG DRUG/ PHARAMCY
BENEFIT
CALL DRIVER FORMULARY

PAG ABOUT SA REJ

CALL DRIVER RX REJ

PAG ABOUT PA ON FILE/ NEED BA NG

PA ANG GAMOT?
CALL DRIVER COVERAGE
DETERMINATION- STATUS/ REQUEST
(OFFER DER GAMIT UNG SPIEL.
PAG APPEAL ANG BUNGAD
CALL DRIVER APPEAL

PAG COPAY BUNGAD

GEN PHARMACY INFO- COPAY/TROOP

PAG THERACOM (KEYWORD ON

BEHALF OF PROVIDER)
GEN PHARMACY INFO- THERACOM

PAG PROCESSING INFO ANG BUNGAD

GEN PHARMACY- PROCESSING INFO-
RX BIN 004336
RX PCM MEDDADV
RX GROUP 788257
COB CONCERN
GEN INFO- COB (CALL
REPRESENTATIVE PAG MATAGAL
INFORM SI CALLER. (THERE IS HIGH
VOLUME IN CALL FOR
REPRESENTATIVE I NEED TO TRY TO
CALL LATER.IS IT OKAY IF I CALL
YOU BACK)