Faxe Process Analysis

When a technician receives a fax, there is varies steps that the faxes go through before member is notified. A technician will first open up pas and hit get next fax. The technician should always open up the Part D faxes first to work then continue to the other work baskets. After selecting hit next fax, the technician will open up an attatchment, which will be the fax image to work the case. Some faxes is barcoded and all the information will be prefilled but a tech should always verify that the information is correct. The technician will verify that the npi matches and then select submit. The technician will then need to verify the provider name, address, phone number and fax number is correct, then hit submit. If those or correct and update, …show more content…
The technican will then follow the bedcrumb and verify the member id then click submit. The technician will then have to verify is the member information number match such as dob and …show more content…
The subject will be title trial claim and the verbiage from the trial claim in rxhd will be the body. Then a phone call will be made to the member about the decision. But if you enter all the guillines question, the case will pend to the pharmacist. The pharmacist will make a deciosnion based off the information that is given. If something need clarification, the pharmaxcist will then send the case to the incomplete work basked where the mdo will get two attempt to complete with much needed information. The outreach technician will then fax a first attempt to the mdo office, if nothing is received, then the member will do a secong attempt due to making phone calls and send out an additional fax. The technician receives additional information on the guillines question, then the case will either pend to the pharmacist or spprove. If the case is a approved then a call will be made to member about the decieseion but if the case pends to the pharmacist again. A pharmacist will come up with a decision based off the information provided, then after the member will receive a call to know whether or not their case is approved or