Help please... new Walgreen's Tech

[mochiPharmD]

Hi. I'm a new Walgreens tech and been browsing through old threads but have a couple of questions if someone can explain to me.

What does it means if a patient's medication status is STRD / HELD (stored?). Does that just means that it was previously filled, never picked up and returned back to stock? Also, if a patient calls and asks for specific medications to be held, how can I do this?

What does it means when a prescription is CL (closed?). I have had a couple of patients called in. trying to refill a closed prescription, and when I tell them that it's closed they get aggravated because they say that they should still have refills remaining. Usually, I just put the rx through as a new rx, sometimes it goes through, other times its a WCB/CMD. Why is this?

What should I do if there is a DUR push button reject TRP?

If a prescription required a PA, what should be done? Should I fax the MD in the exceptions que, or just notify the patient to contact their PCP to call the insurance company. What I see techs at my store do is just create an exceptions note.

A patient calls in to refill their prescription that had required a PA. They say that their MD had called their insurance to authorize their medication. What are the steps to remove the PA and re-bill insurance?

What are some insurance billing codes? The only ones I'm familiar with is MAMBA, ECRE and HNET (sad, I know).

How do you check the faxes? Usually I hit SHIFT/CTRL+F1, but can only view one, and can't flip through the others.

When typing in F1, how can you flip through other scripts to skip the one that you are on?

thank you!

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[theyungmamba23]

i am really new as well.

can u explain MAMBA? ECRE, HNET?

I KNOW CALOP IS FOR CAL OPTIMA,
FPACT
CABS IS BLUE SHIELD I THINK
PERX NOT SURE WHAT ITS FOR
CAMED

can someone please go through the very most common ones.. also when the patient does not have their info for insurance how to look up the information in the computer

how do i approve a prior authorization if a office calls to approve it?

 

[Lnsean]

Hi. I'm a new Walgreens tech and been browsing through old threads but have a couple of questions if someone can explain to me.

What does it means if a patient's medication status is STRD / HELD (stored?). Does that just means that it was previously filled, never picked up and returned back to stock? Also, if a patient calls and asks for specific medications to be held, how can I do this?

What does it means when a prescription is CL (closed?). I have had a couple of patients called in. trying to refill a closed prescription, and when I tell them that it's closed they get aggravated because they say that they should still have refills remaining. Usually, I just put the rx through as a new rx, sometimes it goes through, other times its a WCB/CMD. Why is this?

What should I do if there is a DUR push button reject TRP?

If a prescription required a PA, what should be done? Should I fax the MD in the exceptions que, or just notify the patient to contact their PCP to call the insurance company. What I see techs at my store do is just create an exceptions note.

A patient calls in to refill their prescription that had required a PA. They say that their MD had called their insurance to authorize their medication. What are the steps to remove the PA and re-bill insurance?

What are some insurance billing codes? The only ones I'm familiar with is MAMBA, ECRE and HNET (sad, I know).

How do you check the faxes? Usually I hit SHIFT/CTRL+F1, but can only view one, and can't flip through the others.

When typing in F1, how can you flip through other scripts to skip the one that you are on?

thank you!

1. STRD/HELD are valid NEW prescriptions that have not been filled or filled but put back onto the pt's profile. This happens for various reasons--it was not covered by the pt's insurance, the pt does not want it yet, it was too soon to be filled, it was never picked up after 10 days. You can fill a STORED/HELD script by selecting script and creating new from OPTIONS drop down menu.

CLOSED prescriptions---are NOT VALID---and should never be filled. A script may be closed for various reasons: the original script may have been transferred out, the prescribe discontinued the medication, the pt requested to have it closed, etc. The only time you may select a closed script is when you need to generate a template to fax the doctor for refills for that particular script at the pt's request.

2. DURs---90% of the time....this is for the pharmacist to override. There will be some that you can override because it's not a true DUR but a TPR rejecting as as DUR. You will learn which one you can and which one you cannot override with experience.

3. IF PA is required----Create an EXCEPTION so that you don't lose the script. ALWAYS create an exception before you walk up to your pharmacist with a question because he will not be able to see it on his computer if it's stuck on your screen. It will then be a TPR in the work queue----fax the doctor regarding the PA and inform the pt. At the end of the day---store the prescription.

4. Take the script out of STORED/HELD and attempt to resubmit it to the insurance. IF it goes through---then the PA was approved. If it still rejects, inform the pt that the PA may still be in progress or that the MD probably forgot to do it (lol)

5. I am from NJ so the codes are different---most of these will be learned from experience

6. I have yet to figure out how to flip through faxes.

7. You can continue to hit F1--but you will only be able to have a certain number of F1 scripts open at a time. The other way to script around is through manual rx entry when you bring up the pt's profile. But your KPI will be penalized if you do this. You are supposed to enter scripts as they come up through F1.

 

[txpharmguy]

Don't store prior authorizations after submitting fax to MD. Keep in queue for 7 days, retrying daily to see it goes through. If no approval after 7 days, annotate rx that no prior authorization approved and then call pt to follow up with his/her insurance regarding authorization of said drug. Afterwards, store rx

 

[molyhelp]

Don't store prior authorizations after submitting fax to MD. Keep in queue for 7 days, retrying daily to see it goes through.

Agree, that's smart. If script is not in queue, we will forget and patient will get mad.

If no approval after 7 days, annotate rx that no prior authorization approved

That's good notes so others will know.

and then call pt to follow up with his/her insurance regarding authorization of said drug.

I would call patient and tell patient to contact doctor, not insurance. Why?
I explained to patient that:
Your medications needs your doctor to do 1 extra step for you. In insurance language, insurance says doctor must do PRIOR AUTHORIZATION. Between you and me in plain language, insurance is being cheap, insurance does not want to pay this, insurance wants your doctor to INSIST WITH INSURANCE SO INSURANCE WILL PAY FOR YOU. Please remember, pharmacy is your friend. The hiccup is not pharmacy. The hiccup is at insurance and only your doctor office can help you through this hiccup. Please help me help you by contacting your doctor office so your doctor office can insist with insurance for you. Now, the trick is, people at doctor's office can help you. Sometimes, they just fax to insurance and will not have to bother doctor. Please help me help you. You are more powerful than me because you bring business to doctor, and doctor has seen you personally, I am only a pharmacy on the road which doctor has not seen. You have the power to help me help you here. Here is the phone number for your doctor to insist with insurance.....

Believe me, I handle over 30 PA cases a month for many years. That's how I talk with patient and no one ever got mad at me.
On my side, I promise the patient that I will keep trying every few days and will setup my computer to announce automatically the moment the script is ready.

The patient understands clearly the process and help me along...

Another note:

People at doctor office may not know what PA is. The girls or guys there may be experienced assistant or brand new assistant. I have had conversations with enough assistants to know a fact: you have a mixture of people at doctor's office just like you have a mixture of people at pharmacy: new or experienced.
Therefore, we have had many faxes from pharmacy to doctor and doctor office simply sign and fax back to pharmacy to AUTHORIZE PRIOR AUTHORIZATION TO PHARMACY.
That's wrong action. Doctor must authorize PRIOR AUTHORIZATION TO INSURANCE, not to pharmacy.

So, I have a paragraphs like this:
Insurance is not paying yet until you insist. Please insist with insurance by giving PRIOR AUTHORIZATION TO INSURANCE. The contact number to give PRIOR AUTHORIZATION TO INSURANCE is 1-800-.... or you can fax to 1-800-....
Thank you for your help.

See how many times I wrote insurance? Since I used that phrase, never had any misunderstanding between pharmacy and doctor office. They know clearly what to do.

Also, if I have a chance, I give a copy of this faxed PA to patient and asked patient to help me push doctor to give PRIOR AUTHORIZATION. This trick worked very well. Patient is very vocal and powerful.

My way seems complicated but I simply try cover many angles and minimize misunderstanding. My coworkers simply wrote, please do P.A. and misunderstandings sometimes happened.

Hope that helps someone avoid hiccups...

 

[txpharmguy]

Agree, that's smart. If script is not in queue, we will forget and patient will get mad.


That's good notes so others will know.



I would call patient and tell patient to contact doctor, not insurance. Why?

Because insurance is one blocking it. Pharmacy has done it's part. What I tell people is to call insurance to check on status of prior authorization. Insurance company can fax MD appropriate form if not received from prescriber. Also, MD may have already sent, but claim still under review.

 

[Lnsean]

Don't store prior authorizations after submitting fax to MD. Keep in queue for 7 days, retrying daily to see it goes through. If no approval after 7 days, annotate rx that no prior authorization approved and then call pt to follow up with his/her insurance regarding authorization of said drug. Afterwards, store rx

This is only practical in slow stores. If you leave it in TPR for 7 days at any high volume store, you will have TPRs in the 100s. I have never worked at a store that has kept scripts like that for more than 1-2 days in queue.

 

[farmadiazepine]

OMG please don't try to explain to patients what a prior authorization is.

When you get a message for a prior authorization on your end, there is only one thing to say to the customer.

"Your insurance doesn't cover this medication. You want us to call the doctor to change it for you?"

That's it. There's no explaining what a PA is and the entire process and them getting confused. Let the RPh or the tech call the MD and tell them its not covered, it needs a PA, let the OFC decide to either change it or call for the PA. Do you see how some people's entire paragraphs got cut down to 2 sentences here?

If customer insists that this medicine is the only one they can take, then you tell them "Your doctor has to call this phone number for you to get this medicine. We'll tell them the same thing tomorrow."

That's it. That's how it works in fast food pharmacy. End of story.

In summary:
WTF is a prior authorization?

 

[farmadiazepine]

This is only practical in slow stores. If you leave it in TPR for 7 days at any high volume store, you will have TPRs in the 100s. I have never worked at a store that has kept scripts like that for more than 1-2 days in queue.

Agreed. If you leave it in busy stores, your asking for trouble.

 

[txpharmguy]

This is only practical in slow stores. If you leave it in TPR for 7 days at any high volume store, you will have TPRs in the 100s. I have never worked at a store that has kept scripts like that for more than 1-2 days in queue.

While I agree that the TPR numbers would be higher for high volume stores, who cares? If you store after 1-2 days, pt will call back and it'll be in the queue again. A lot of TPRs are due to refill too soon, both in TPR and RTS queue. Case in point: new eRx comes over today and next fill date is 4/30. However, looking at pt profile, last sold on 4/7. If filled on 4/30, it will most likely be on deletion list. If pt is due in < 7 days, leave in queue. Fwiw, I've been an RXM at high volume store for a long time.