MED D

Course Objectives Upon completion of this training, you will be able to utilize the following Med D policies and procedures to meet CMS requirements: . Involuntary Disenrollment for Disruptive Behavior . Gap Discount Customer Care Process . Handling Medicare Part B Calls . Emergency Disaster - Emergency Fill Plan . Mail Order Expedited Order Requests . Fraud, Waste and Abuse Reporting . Customer Care Call Center Requirements . Language Assistance for Customer Care . Medicare Part D SHIP Counselors (SilverScript) . Medicare Part D SHIP Counselors (Customer Care) . Medicare Part D BAE Process . Medicare Part D BAE Process (Contracted) . Disaster Recovery and Business Continuity

Involuntary Disenrollment for Disruptive Behavior

• Policy and Procedure ID : Call - 0014
• This Policy and Procedure outlines the process for when an involuntary disenrollment for disruptive behavior is executed.

Gap Discount Customer Care Process

• Policy and Procedure ID : Call -0074
• This policy and procedure outlines the steps to take in order to support a call from a Medicare Part D Beneficiary and others calling on their behalf. Customer Care utilizes resources and training in order to support callers and answer questions related to the Coverage Gap Discount Program.

Handling Medicare Part B Calls

• Policy and Procedure ID : Call - 0016
• The purpose of this document is to provide the policy and procedures for handling Medicare Part B calls. All Medicare Part B eligible prescriptions will be processed in accordance with Federal regulations.

Emergency Disaster - Emergency Fill Plan

• Policy and Procedure ID : Call - 0062
• This policy and procedure outlines the action steps taken on behalf of CVS Caremark Part D Services, L.L.C. clients to provide Emergency access to Part D medications during a federal disaster or public health Emergency declaration.

Mail Order Expedited Order Requests

• Policy and Procedure ID : MEDD-050546
• To establish a policy and procedure that identifies how CVS Caremark Part D Services, L.L.C. Customer Care Agents provide assistance to Medicare Part D Beneficiaries requesting expedited shipping of a prescription(s) at the Mail Order Pharmacy.

Fraud, Waste and Abuse Reporting -Policy and Procedure ID : DOC-042209

• The purpose of this policy and procedure is to outline the process for escalating fraud, waste and abuse allegations to the Medicare Part D

Customer Care Call Center Requirements -Policy and Procedure ID: CALL-0048

• This Policy and Procedure includes the Customer Care Representatives (CCR) requirements used to provide the Beneficiary with the information they need to understand and use their pharmacy benefit. When providing this information, the CCR must always adhere to the company policies that adhere to the following Health Insurance Portability and Accountability Act (HIPAA) regulations: Authorization for Use and Disclosure of Protected Health Information (PHI) and Minimum Necessary Use and Disclosure of Protected Health Information and Electronic Protected Health Information (ePHI) policies. This includes reference to third party entities such as Appointed Representatives, Ombudsman and State Health Insurance Assistance Program (SHIPS) Counselor. The CCR is expected to use all tools currently available to them in order to provide the Plan Member with the most up to date information.

Language Assistance for Customer Care

• Policy and Procedure ID: CALL-0015
• The purpose of this document is to establish and maintain the process that Customer Care Representatives utilize in order to provide language assistance to all non-English speaking and limited English proficient Beneficiaries.

Medicare Part D SHIP Counselors (SilverScript)

• Policy and Procedure ID: CALL-0055
• This policy and procedure outlines the steps to take if a call is received from a State Health Insurance Assistance Program (SHIP) counselor, who is requesting assistance in aiding a SilverScript Insurance Company (SSIC) Medicare Part D Beneficiary.

Medicare Part D SHIP Counselors (Customer Care)

• Policy and Procedure ID: CALL-0057
• This policy and procedure outlines the steps to take if a call is received from a State Health Insurance Assistance Program (SHIP) counselor, who is requesting assistance in aiding a Medicare Part D Beneficiary.

Medicare Part D BAE Process

• Policy and Procedure ID: CALL-0070
• This policy and procedure identifies the process CVS Caremark Part D Services, L.L.C. Medicare Part D Customer Care Representatives (CCR) follow as contracted to provide delegated services to assist Low Income Subsidy (LIS) eligible Beneficiaries with requests for urgent need of medication. The Beneficiary may or may not have Best Available Evidence (BAE) documentation of eligibility to Low Income Subsidy or Extra Help.

Medicare Part D BAE Process (Contracted)

• Policy and Procedure ID: DOC-052232
• This policy and procedure identifies the policy CVS Caremark Part D Services, L.L.C. Medicare Part D Customer Care Representatives (CCR) follow to assist low income subsidy Beneficiaries with requests for urgent need of medication, obtain Best Available Evidence (BAE) documentation of Low Income Subsidy (LIS) and/or request Centers for Medicare and Medicaid Services (CMS) review of eligibility to low income subsidy as appropriate. The Beneficiary may or may not have BAE documentation.

Disaster Recovery and Business Continuity

• Policy and Procedure ID: CALL-0080
• This policy and procedure describes the operational process used to implement a business continuity plan to ensure continuing Beneficiary or pharmacy support in the event of a building closure due to emergency, inclement weather, or other potential service interruption.

daddy joe