PANDA Workflow

What happens if the Manual Eligibility Check screen is unavailable in PANDA?

• The case is completed automatically

• The agent must return to PAS

• The case is canceled

• The agent contacts the member

What is the main action required in the "Appears to Route Away" scenario?

• Close out the case in PANDA.

• Return to the Main Menu, select "Refresh All" and select the case to continue.

• Contact leadership.

• Move to PAS for translation.

What is the proper procedure to complete compounds in PANDA?

• Verify a claim is on file

• Search for the ingredient components

• You complete Compound requests in PAS.

• Ask for a lifeline

What must agents do if PANDA does not allow a case to be cancelled as Member Not Found?

• Ignore the case

• Return to PAS

• Complete the case manually

• Send a notification

Who must validate that a case should be cancelled as Member Not Found?

• The agent

• The caller

• Leadership

• The pharmacist

For cases requiring an ePA Key search (i.e., scenarios when only the ePA Key number is available), agents must?

(a)  

When is it inappropriate to offer an epa?

• Compound medications

• Tier cost exception requests

• Plan exclusions

• When the requestor wants to initiate an Appeal request

The Case Details screen, either as Selected Case Details or Inquiry Case Details depending on the flow, displays applicable tabs for the case (e.g., Correspondence, Case Notes, Clinical Guidelines, and Additional Notes tabs) and not in a Clinicians workbasket, what is the agent able to do?

(a)