Navigating Provider Calls
Make every call count — high quality care and service.
Start
Partnering with Providers: A Shared Committment to Patient Care
As a pharmacy we are more than just a point of service for the patient - we are an extension of the provider's office and a vital part of the patient's healthcare team. When a provider calls, we must communicate clearly, professionally, and confidently with them to ensure patients receive timely and coordinated care.
+Info
Setting the tone
Effective phone communication is a critical part of our role as a telephonic pharmacy. Demonstrating our care with each provider call further establishes our credibility as the best pharmacy option for their patients. When provider offices call, we are not just answering a phone- we are representing the professionalism, reliability, and clinical excellence of our pharmacy. Using a polite and professional tone builds trust, strengthens relationships, and ensures clear, efficient collaboration with providers. How we speak matters just as much as what we say!
Professionalism
Key Phrases
Holding
Provider calls, step by step
Step 4
Step 3
Step 2
Step 1
Provide the caller an update based on what was found, ask clarifying questions, OR ask for support in understanding the account from a team member or lead.
Offer to help with any other patients they have and close the call once resolved.Are there any other patients I can help with today? Thanks for calling. Have a great day!
Review the patient's profile. Progress notes (F) and Orders (B) are key areas to review.Make sure to get the name and title of the person you are speaking with!
Greet the caller. Ask for the patient's name and DOB.I can absolutely help with that! What is the patient's name and date of birth so I can look into their profile?
Provider Call Types
Providers call our office or many reasons, but these are the most common scenarios and how to respond to them!
We discovered a prior authorization is needed for this medication that is preventing the dispense. We may have already started the process to get coverage for the patient.
Providers may call to follow up on a prescription that was just received. The rx may be working through our normal processing time. We typically call patients within 48 hours of receiving their prescription.
During the BI we discovered we are not contracted with the patient's insurance and need to transfer the patient to a different pharmacy. A fax should have been sent to the provider that we need to transfer their patient.
This call focused on the status of a patient's refill that was requested by us or the patient.The provider may authorize the refill, ask if we received the Rx, or explain refill denial reason.
This call focused on a PA request that we sent to the provider or a follow-up from a voicemail to confirm the provider is completing the PA. More information on PA process on next page!
Patients may refuse to fill due to a high copay. Let the provider know the concern and if there are any options we are trying to support the patient (i.e. funding, pharmacist education, etc.)
This call focused on a provider responding to a voicemail or fax we sent to verify what is needed/see if we received their fax back/indicate the information was already sent.
Sometimes an insurance plan requires additional information or documentation to provide coverage for a medication. This is different from a PA.
This call focused on missing information. Provider's may say they have sent the requested information or ask for clarification on what is needed.
Celebrate this win with the provider! Let them know what their copay was on the medication.
Prescription was received, but we haven't contacted the patient yet
Use this side of the card to provide more information about a topic. Focus on one concept. Make learning and communication more efficient.
Use this side of the card to provide more information about a topic. Focus on one concept. Make learning and communication more efficient.
This call focused on if we received a patient's new prescription was received.
Patient Scheduled Order or Was Already Delivered!
Missing Information Request
Patient Refused to Fill Due to High Copay
Prior Authorization Needed
Transfer Needed
Refill Request
PA Request
Payor Issue
New Patient: Status Updates
Fax or Call Follow Up
Title
Title
Write a brief description here
Write a brief description here
Prior Authorization Process
PA Status Check #3/Final
PA Status Check #2
PA Status Check #1
PA Submitted
PA Submitted
PA Initiated
PA Submitted
Prior Authorization Required
PA Approved
PA Submitted
Appeal Initiated
Appeal Review
Appeal Submitted
Discontinuation Reasons
Patients may have therapy discontinued for many different reasons. Below are all of our D/C Last Events. If a provider is calling and a patient is discontinued, depending on the reason, the patient may be able to get on therapy. We can always reactivate their profile and get them their medication! ALWAYS review progress notes!
- D/C due to Can't Afford Copay
- Similar to patients who refused to fill due to copay
- D/C due to Missing Info
- Similar to if the patient is in our regular missing info process. If the provider can get us what is missing, we can dispense!
- D/C due to Therapy Change
- This means the provider changed their therapy due to an adverse reaction, insurance issue, etc. (ex: arformoterol instead of formoterol)
- D/C due to Transferred Out
- Similar to patients tagged Transfer Needed
- D/C due to Unable to Contact
- Confirm the patient's contact information with the provider and see if they have any other phone number to try.
- D/C due to Unable to Obtain Refills
- Let the provider know we did not receive refills for their medication. If they send us refills, we can start to dispense again.
"Are there any other patients I can help with today?"
Asking if the provider has any other patients who may need support reinforces our commitment to partnering with their office, helps streamline communication by addressing additional needs proactively, demonstrates a patient-centered approach, and distinguishes us from other pharmacies by offering added value.
Training Recap
Dos
Don'ts
VS
- Causal phrases ("sure", "no problem", "hang on a sec", etc.)
- Place on multiple holds
- Review only order last events
- Assume you know what is going on with the patient without looking at their full profile
- Speak clearly and confidently
- Get the caller's name and title
- Review the patient profile in depth
- Ask before placing on hold
- Take detailed notes
- Ask if there are any other patients you can help with
- Find ways to work together with the provider
- Share details on how DirectRx has attempted to help patients with insurance, patient care, etc.
Quiz Time!
Start
00:20
00:20
00:30
00:30
Roleplay Scenarios
Start
Roleplay Scenario Practice
Provider called to check the status of a patient they sent over 3 days ago. After checking the patient profile in CPR+, you see the BI was completed with $0 copay for Yupelri, a nebulizer, and cups & tubing, and there is a Scheduled Patient Delivery Note from yesterday.
- What do you tell the provider?
Look at the delivery tickets to check that the order has shipped. Track package if applicable.
This patient scheduled their order! It looks like they scheduled their Yupelri and supplies yesterday for $0 and according to FedEx they should receive it tomorrow.
Check
Roleplay Scenario Practice
Provider called this morning to check the status of a patient they sent yesterday afternoon. After checking the patient profile in CPR+, you see the patient profile was created, but we have yet to complete a BI.
- What do you tell the provider?
Check to make sure we have received insurance information and clinicals, if the patient is Medicare Part B primary. If missing information, attempt to collect from provider. If not missing information, inform of our usual processing time.
If missing information: We have received the prescription and created a profile for this patient, however it seems we did not receive insurance and/or clincials for this patient. Would you be able to send that information over? If not missing information: We have created a profile for this pateint and our insurance team is working on verifying coverage. We should reach out to the patient by the end of the day!
Check
Roleplay Scenario Practice
Provider called to check the status of a patient they sent over last week. After checking the profile, you see the Alert is dated 5 days ago and says "Pt Transferred Out." Orders are tagged D/C Due to Transferred Out. The progress notes indicate we are not contracted with the patient's insurance.
- What do you tell the provider?
Check the progress notes to see if we have contacted the patient and/or office regarding the transfer out.
Unfortunately, we are not contracted with this patient's insurance, so we must transfer them to another pharmacy. We attempted to contact the patient to get their preferred pharmacy and it looks like we faxed a notice to your office as well.
Check
Roleplay Scenario Practice
Provider called to check the status of a patient they sent over 4 days ago. After checking the patient profile in CPR+, you see the BI was completed with $594.24 copay for Ohtuvayre and cash price supplies. There is a Schedule Delivery Attempt Note from 2 days ago and the orders are now in Funding Eligible.
- What do you tell the provider?
Read the Scheduled Delivery Attempt Note to confirm copay cost issue and funding questionnaire completed.
Unfortunately, this patient could not afford their copay of $595. We did refer them back to Verona to get them copay assistance and we completed a questionnarrie with them to get them assistance, but we do not have a timeline of funding.
Check
Roleplay Scenario Practice
Provider is calling in to ask about a fax request they received regarding a prior authorization. They say they typed in the KeyID on the fax and it did not pull up any information. There is a PA Initiated progress note on the patient's profile and the Orders are tagged PA Status Check #1.
- What do you tell the provider?
Read the PA Initiated Progress Note and verify the KeyID is correct that was faxed to the provider. Escalate to team lead if needed!
It looks like our Prior Authorization team left this KeyID in the progress note _________. Does that match what you entered? If no: Can you try that one? If yes: I will escalate your issue to our PA team for additional review. Someone should call back by the end of the day.
Check
Roleplay Scenario Practice
Provider calls in to check the status of a patient they sent over last week. After reviewing the patient profile, you see the orders are tagged D/C Due to Missing Information and we are missing clinicals for this patient, but their Ohtuvayre and supplies are fully covered.
- What do you tell the provider?
Review the account to ensure the clinicals are still missing.
It’s great you called! We are in need of some information to process this patient’s prescription(s). Can you provide us with the most recent clinical notes with a billable diagnose code and the provider's signature included? Great! Our fax number is 877-892-4007. Once we receive those clinicals, we will follow up with the patient to get their medication scheduled for delivery.
Check
Training Complete!
Professional Communication = Courtesy, Clarity, Considerate
Try this: “Certainly” or “Of course” “I’d be happy to assist” “Let me find that for you” “One moment, please” “Thanks for waiting”
Instead of This “Sure” or “No problem” “I guess I can help” “Hang on a sec” “Hold on” “Still there?”
Key Phrases for Polite & Professional Communication
Scenario Need more time Don't know the answer Caller is upset Need to escalate Wrapping up the call
Phrases to Use "Let me double-check that for you, one moment please." "Let me confirm that with our pharmacist and get back to you." "I understand how frustrating this is and I'd like to help." "I'll forward this patient to our clinical/Insurance/PA team right away." "Are there any other patients I can help you with today?"
Missing Information
Insurance & Clinicals Needed, Insurance Needed, Clincials Needed, Rx Clarification
Review patient's progress notes, alert, and last events to confirm what we need from the office. Also review documents to confirm missing information!
Clinicals Needed: "We are missing signed clinicals with a billable diagnosis for this patient. Medicare requires this information before we can dispense the patient's medication. Can you get those sent over to us?"
Insurance Needed: "We are missing insurance information for this patient. We attempted to contact them to receive it as well. Are you able to provide me with their insurance information now?"
Rx Clarification: "Our clinical team indicated that the prescription received requires a clarification due to _________. Can you send us an updated prescription to clarify that? Or I can transfer you to someone from that team is you'd like to discuss."
BI Needed
Orders tagged BI Needed, BI Needed - Level 1, or Training to Be Reviewed
Review patient's documents to ensure we received insurance information or ask the provider to provide the insurance information over the phone!
"I see we received this prescription yesterday. We are confirming benefit details for this medication to ensure the lowest possible out-of-pocket cost, and will follow-up with the patient within the next 1-2 days”
Copay Too High
Copay Review, D/C Due to Can't Afford Copay, Funding Eligible, Funding Qualified
Review patient's alert and progress notes to get the most update information.
"Unfortunately, this patient could not afford their copay of ____. We did complete a funding questionnaire with them, and have them on a waitlist to receive funding assistance from one of the nonprofit foundations we work with, and their application will be submitted as soon as the foundation opens up for applicants" HUB Patient: "Unfortunately, this patient could not afford their copay of ____. We did refer them back to Verona."
Refill Request
Orders in List I
Review patient's progress notes and orders to get the most up-to-date information! Are there any refills waiting to be set up in List 3 or Additional Refills in List 4?
“It's great you called. This patient is close to being out of refills of their [Medication/Supply]. Would you be able to send us additional refills for this patient?" If the provider wants to authroize additional refills via a verbal order, transfer to pharmacist using PCC/Pharmacist chat!
Holding: Best Practices
Ask before placing someone on hold: “Would it be alright if I place you on a brief hold while I check that information?" Thank them when you return and update them if it's been longer than a minute: “Thank you for holding- I appreciate your patience.” “Thank you for holding. I’m still waiting on that update- would you prefer to continue holding or would you like a call back?” If you are transferring them, let them know who is picking up: "I am about to transfer you to one of our pharmacists, Myrna." Do not place someone on multiple holds! Use one hold to find out all information.
Patient Scheduled
., Scheduled Ready to Bill, Scheduled - Intervention Needed, Scheduled, etc.
Review patient's progress notes to confirm that the patient scheduled and delivery truck to ensure the order went out/it was delivered.
"This patient scheduled their medication! It looks like they scheduled their Yupelri, Formoterol, and Budesonide for $0 and they should have received it yesterday!"
How often do patients speak to their provider compared to their pharmacy?
Patients connect with their pharmacy four times more often than with their provider on average. Our frequent interactions with patients provide a powerful opportunity to support the providers' office by reinforcing care plans, boosting adherence, and delivering patient education.
PA Follow Up
PA Initiated, PA Status Check #1, PA Status Check #2
Review patient's alert and progress notes to get the most update information!
“This patient’s insurance requires a Prior Authorization for the medication. Our PA Specialists have started the PA through CoverMyMeds/External Form. Have you received the KeyID/External Form from us? Can your office complete the PA to the insurance plan?”
The next page will provide more detail on our PA process!
Payor Issue
BI Needed - Level 2 or Hold Payor Issue
Review progress notes to understand what the issue is and who is working on resolving the issue. Let the team member who worked on the patient last know that the provider followed up after the call.
"This patient’s insurance is requiring some additional escalation, but our insurance specialists are working diligently to get the most accurate information. We will follow up with the patient within the next 2-3 days"
PA Required
PA Required
Review patient's alert and progress notes to get the most update information.
“This patient’s insurance is requiring a Prior Authorization. Our PA Specialists will have a CMM Key ID or a pre-populated Prior Authorization form faxed to you within the next 24 hours.”
The next page will provide more detail on our PA process!
Transfer Needed
Transfer Needed
Review progress notes to understand what the issue is and verify that a fax was sent to the provider regarding the transfer reason.
"Unfortunately we are not contracted with this patient's insurance and we had to transfer it out. We followed up with the patient and sent a fax to you." HUB Patients: "Unfortunately we are not contracted with this patient's insurance. We informed the Verona HUB and they transferred the patient to an in-network pharmacy."
Navigating Provider Calls
Semia Clay
Created on September 26, 2025
Start designing with a free template
Discover more than 1500 professional designs like these:
View
Essential Learning Unit
View
Akihabara Learning Unit
View
Genial learning unit
View
History Learning Unit
View
Primary Unit Plan
View
Vibrant Learning Unit
View
Art learning unit
Explore all templates
Transcript
Navigating Provider Calls
Make every call count — high quality care and service.
Start
Partnering with Providers: A Shared Committment to Patient Care
As a pharmacy we are more than just a point of service for the patient - we are an extension of the provider's office and a vital part of the patient's healthcare team. When a provider calls, we must communicate clearly, professionally, and confidently with them to ensure patients receive timely and coordinated care.
+Info
Setting the tone
Effective phone communication is a critical part of our role as a telephonic pharmacy. Demonstrating our care with each provider call further establishes our credibility as the best pharmacy option for their patients. When provider offices call, we are not just answering a phone- we are representing the professionalism, reliability, and clinical excellence of our pharmacy. Using a polite and professional tone builds trust, strengthens relationships, and ensures clear, efficient collaboration with providers. How we speak matters just as much as what we say!
Professionalism
Key Phrases
Holding
Provider calls, step by step
Step 4
Step 3
Step 2
Step 1
Provide the caller an update based on what was found, ask clarifying questions, OR ask for support in understanding the account from a team member or lead.
Offer to help with any other patients they have and close the call once resolved.Are there any other patients I can help with today? Thanks for calling. Have a great day!
Review the patient's profile. Progress notes (F) and Orders (B) are key areas to review.Make sure to get the name and title of the person you are speaking with!
Greet the caller. Ask for the patient's name and DOB.I can absolutely help with that! What is the patient's name and date of birth so I can look into their profile?
Provider Call Types
Providers call our office or many reasons, but these are the most common scenarios and how to respond to them!
We discovered a prior authorization is needed for this medication that is preventing the dispense. We may have already started the process to get coverage for the patient.
Providers may call to follow up on a prescription that was just received. The rx may be working through our normal processing time. We typically call patients within 48 hours of receiving their prescription.
During the BI we discovered we are not contracted with the patient's insurance and need to transfer the patient to a different pharmacy. A fax should have been sent to the provider that we need to transfer their patient.
This call focused on the status of a patient's refill that was requested by us or the patient.The provider may authorize the refill, ask if we received the Rx, or explain refill denial reason.
This call focused on a PA request that we sent to the provider or a follow-up from a voicemail to confirm the provider is completing the PA. More information on PA process on next page!
Patients may refuse to fill due to a high copay. Let the provider know the concern and if there are any options we are trying to support the patient (i.e. funding, pharmacist education, etc.)
This call focused on a provider responding to a voicemail or fax we sent to verify what is needed/see if we received their fax back/indicate the information was already sent.
Sometimes an insurance plan requires additional information or documentation to provide coverage for a medication. This is different from a PA.
This call focused on missing information. Provider's may say they have sent the requested information or ask for clarification on what is needed.
Celebrate this win with the provider! Let them know what their copay was on the medication.
Prescription was received, but we haven't contacted the patient yet
Use this side of the card to provide more information about a topic. Focus on one concept. Make learning and communication more efficient.
Use this side of the card to provide more information about a topic. Focus on one concept. Make learning and communication more efficient.
This call focused on if we received a patient's new prescription was received.
Patient Scheduled Order or Was Already Delivered!
Missing Information Request
Patient Refused to Fill Due to High Copay
Prior Authorization Needed
Transfer Needed
Refill Request
PA Request
Payor Issue
New Patient: Status Updates
Fax or Call Follow Up
Title
Title
Write a brief description here
Write a brief description here
Prior Authorization Process
PA Status Check #3/Final
PA Status Check #2
PA Status Check #1
PA Submitted
PA Submitted
PA Initiated
PA Submitted
Prior Authorization Required
PA Approved
PA Submitted
Appeal Initiated
Appeal Review
Appeal Submitted
Discontinuation Reasons
Patients may have therapy discontinued for many different reasons. Below are all of our D/C Last Events. If a provider is calling and a patient is discontinued, depending on the reason, the patient may be able to get on therapy. We can always reactivate their profile and get them their medication! ALWAYS review progress notes!
"Are there any other patients I can help with today?"
Asking if the provider has any other patients who may need support reinforces our commitment to partnering with their office, helps streamline communication by addressing additional needs proactively, demonstrates a patient-centered approach, and distinguishes us from other pharmacies by offering added value.
Training Recap
Dos
Don'ts
VS
Quiz Time!
Start
00:20
00:20
00:30
00:30
Roleplay Scenarios
Start
Roleplay Scenario Practice
Provider called to check the status of a patient they sent over 3 days ago. After checking the patient profile in CPR+, you see the BI was completed with $0 copay for Yupelri, a nebulizer, and cups & tubing, and there is a Scheduled Patient Delivery Note from yesterday.
Look at the delivery tickets to check that the order has shipped. Track package if applicable.
This patient scheduled their order! It looks like they scheduled their Yupelri and supplies yesterday for $0 and according to FedEx they should receive it tomorrow.
Check
Roleplay Scenario Practice
Provider called this morning to check the status of a patient they sent yesterday afternoon. After checking the patient profile in CPR+, you see the patient profile was created, but we have yet to complete a BI.
Check to make sure we have received insurance information and clinicals, if the patient is Medicare Part B primary. If missing information, attempt to collect from provider. If not missing information, inform of our usual processing time.
If missing information: We have received the prescription and created a profile for this patient, however it seems we did not receive insurance and/or clincials for this patient. Would you be able to send that information over? If not missing information: We have created a profile for this pateint and our insurance team is working on verifying coverage. We should reach out to the patient by the end of the day!
Check
Roleplay Scenario Practice
Provider called to check the status of a patient they sent over last week. After checking the profile, you see the Alert is dated 5 days ago and says "Pt Transferred Out." Orders are tagged D/C Due to Transferred Out. The progress notes indicate we are not contracted with the patient's insurance.
Check the progress notes to see if we have contacted the patient and/or office regarding the transfer out.
Unfortunately, we are not contracted with this patient's insurance, so we must transfer them to another pharmacy. We attempted to contact the patient to get their preferred pharmacy and it looks like we faxed a notice to your office as well.
Check
Roleplay Scenario Practice
Provider called to check the status of a patient they sent over 4 days ago. After checking the patient profile in CPR+, you see the BI was completed with $594.24 copay for Ohtuvayre and cash price supplies. There is a Schedule Delivery Attempt Note from 2 days ago and the orders are now in Funding Eligible.
Read the Scheduled Delivery Attempt Note to confirm copay cost issue and funding questionnaire completed.
Unfortunately, this patient could not afford their copay of $595. We did refer them back to Verona to get them copay assistance and we completed a questionnarrie with them to get them assistance, but we do not have a timeline of funding.
Check
Roleplay Scenario Practice
Provider is calling in to ask about a fax request they received regarding a prior authorization. They say they typed in the KeyID on the fax and it did not pull up any information. There is a PA Initiated progress note on the patient's profile and the Orders are tagged PA Status Check #1.
Read the PA Initiated Progress Note and verify the KeyID is correct that was faxed to the provider. Escalate to team lead if needed!
It looks like our Prior Authorization team left this KeyID in the progress note _________. Does that match what you entered? If no: Can you try that one? If yes: I will escalate your issue to our PA team for additional review. Someone should call back by the end of the day.
Check
Roleplay Scenario Practice
Provider calls in to check the status of a patient they sent over last week. After reviewing the patient profile, you see the orders are tagged D/C Due to Missing Information and we are missing clinicals for this patient, but their Ohtuvayre and supplies are fully covered.
Review the account to ensure the clinicals are still missing.
It’s great you called! We are in need of some information to process this patient’s prescription(s). Can you provide us with the most recent clinical notes with a billable diagnose code and the provider's signature included? Great! Our fax number is 877-892-4007. Once we receive those clinicals, we will follow up with the patient to get their medication scheduled for delivery.
Check
Training Complete!
Professional Communication = Courtesy, Clarity, Considerate
Try this: “Certainly” or “Of course” “I’d be happy to assist” “Let me find that for you” “One moment, please” “Thanks for waiting”
Instead of This “Sure” or “No problem” “I guess I can help” “Hang on a sec” “Hold on” “Still there?”
Key Phrases for Polite & Professional Communication
Scenario Need more time Don't know the answer Caller is upset Need to escalate Wrapping up the call
Phrases to Use "Let me double-check that for you, one moment please." "Let me confirm that with our pharmacist and get back to you." "I understand how frustrating this is and I'd like to help." "I'll forward this patient to our clinical/Insurance/PA team right away." "Are there any other patients I can help you with today?"
Missing Information
Insurance & Clinicals Needed, Insurance Needed, Clincials Needed, Rx Clarification
Review patient's progress notes, alert, and last events to confirm what we need from the office. Also review documents to confirm missing information!
Clinicals Needed: "We are missing signed clinicals with a billable diagnosis for this patient. Medicare requires this information before we can dispense the patient's medication. Can you get those sent over to us?"
Insurance Needed: "We are missing insurance information for this patient. We attempted to contact them to receive it as well. Are you able to provide me with their insurance information now?"
Rx Clarification: "Our clinical team indicated that the prescription received requires a clarification due to _________. Can you send us an updated prescription to clarify that? Or I can transfer you to someone from that team is you'd like to discuss."
BI Needed
Orders tagged BI Needed, BI Needed - Level 1, or Training to Be Reviewed
Review patient's documents to ensure we received insurance information or ask the provider to provide the insurance information over the phone!
"I see we received this prescription yesterday. We are confirming benefit details for this medication to ensure the lowest possible out-of-pocket cost, and will follow-up with the patient within the next 1-2 days”
Copay Too High
Copay Review, D/C Due to Can't Afford Copay, Funding Eligible, Funding Qualified
Review patient's alert and progress notes to get the most update information.
"Unfortunately, this patient could not afford their copay of ____. We did complete a funding questionnaire with them, and have them on a waitlist to receive funding assistance from one of the nonprofit foundations we work with, and their application will be submitted as soon as the foundation opens up for applicants" HUB Patient: "Unfortunately, this patient could not afford their copay of ____. We did refer them back to Verona."
Refill Request
Orders in List I
Review patient's progress notes and orders to get the most up-to-date information! Are there any refills waiting to be set up in List 3 or Additional Refills in List 4?
“It's great you called. This patient is close to being out of refills of their [Medication/Supply]. Would you be able to send us additional refills for this patient?" If the provider wants to authroize additional refills via a verbal order, transfer to pharmacist using PCC/Pharmacist chat!
Holding: Best Practices
Ask before placing someone on hold: “Would it be alright if I place you on a brief hold while I check that information?" Thank them when you return and update them if it's been longer than a minute: “Thank you for holding- I appreciate your patience.” “Thank you for holding. I’m still waiting on that update- would you prefer to continue holding or would you like a call back?” If you are transferring them, let them know who is picking up: "I am about to transfer you to one of our pharmacists, Myrna." Do not place someone on multiple holds! Use one hold to find out all information.
Patient Scheduled
., Scheduled Ready to Bill, Scheduled - Intervention Needed, Scheduled, etc.
Review patient's progress notes to confirm that the patient scheduled and delivery truck to ensure the order went out/it was delivered.
"This patient scheduled their medication! It looks like they scheduled their Yupelri, Formoterol, and Budesonide for $0 and they should have received it yesterday!"
How often do patients speak to their provider compared to their pharmacy?
Patients connect with their pharmacy four times more often than with their provider on average. Our frequent interactions with patients provide a powerful opportunity to support the providers' office by reinforcing care plans, boosting adherence, and delivering patient education.
PA Follow Up
PA Initiated, PA Status Check #1, PA Status Check #2
Review patient's alert and progress notes to get the most update information!
“This patient’s insurance requires a Prior Authorization for the medication. Our PA Specialists have started the PA through CoverMyMeds/External Form. Have you received the KeyID/External Form from us? Can your office complete the PA to the insurance plan?”
The next page will provide more detail on our PA process!
Payor Issue
BI Needed - Level 2 or Hold Payor Issue
Review progress notes to understand what the issue is and who is working on resolving the issue. Let the team member who worked on the patient last know that the provider followed up after the call.
"This patient’s insurance is requiring some additional escalation, but our insurance specialists are working diligently to get the most accurate information. We will follow up with the patient within the next 2-3 days"
PA Required
PA Required
Review patient's alert and progress notes to get the most update information.
“This patient’s insurance is requiring a Prior Authorization. Our PA Specialists will have a CMM Key ID or a pre-populated Prior Authorization form faxed to you within the next 24 hours.”
The next page will provide more detail on our PA process!
Transfer Needed
Transfer Needed
Review progress notes to understand what the issue is and verify that a fax was sent to the provider regarding the transfer reason.
"Unfortunately we are not contracted with this patient's insurance and we had to transfer it out. We followed up with the patient and sent a fax to you." HUB Patients: "Unfortunately we are not contracted with this patient's insurance. We informed the Verona HUB and they transferred the patient to an in-network pharmacy."