March 23, 2020
Attention Valued Partner:
In this time of uncertainty, staying informed is essential. Therefore, we will regularly communicate updates and talking points. Rest assured, we are still closely monitoring the coronavirus (COVID-19) situation and are engaging regularly with medical professionals, the Centers for Disease Control (CDC), the World Health Organization (WHO), and other government agencies, as the situation evolves.
Helping Members Feel Supported
With so many things changing, it is important that our members know they are supported. We are here to help members manage their conditions and stay healthy.
- Members can fill prescriptions early if needed.
- Many pharmacies are offering free local delivery. If a member’s pharmacy isn’t offering free local delivery, they should consider CVS mail order or another local pharmacy (of the members’ choice).
- Convert medications to 90-day supply home delivery.
- This process can take time, will generally require providers to be involved, and requires time for mail delivery.
- There are two ways to set up 90-day supply home delivery: visit the CVS website www.Caremark.com or call 1-866-808-7471 TTY: 711
Food & Basic Essentials
When in need, we are here to help and connect members to our Community Connections Help Line, who help members find local resources. The Community Connections Line is 1-866-775-2192, TTY: 1-855-628-7552. Please understand, this service is experiencing higher than usual call volumes and higher demand for all supplies. We will continue to work with our members to meet their needs as best as possible.
When to Call a Doctor
If your member thinks he/she has been exposed to COVID-19 and develop a fever and symptoms, such as cough or difficulty breathing, advise them to call their healthcare provider for medical advice.
Telephonic MAPD Marketing Presentation
Due to the current state of COVID-19 as of 3/16/2019, WellCare will allow agents to conduct telephonic MAPD sales appointments with beneficiaries!
Remember, when conducting telephonic MAPD marketing presentations to Medicare prospects seeking only MAPD information; all current CMS Medicare Marketing Guidelines, WellCare policies, etc. must be followed.
MAPD Telephonic Marketing Presentation Do’s and Don’ts
After all CMS requirements are met including consent-to-contact and SOA, an agent may proceed with a telephonic MAPD marketing presentation and assist with formulary/physician searches.
If the prospect agrees to enroll, the agent MAY:
- Provide PURL information to the prospect; or
- Send paper application (and all required documents) to be completed by the prospect
If the prospect agrees to enroll, the agent MAY NOT conduct telephonic enrollments on behalf of the prospect.
Protecting our members, employees, and partners conducting home visits
- Centene is taking steps to cover COVID-19 testing and screening services for Medicaid, Medicare, and Marketplace members and is waiving all associated member cost-share amounts for COVID-19 testing and screening.
- We will not require prior authorization, prior certification, prior notification, or step therapy protocols for COVID-19 testing and screening.
- Enhanced protocols have also been created to ensure our pharmaceutical services continue to be available for members through supply chain management.
- To lower the risk of transmission of illness we suggest taking precautions, such as reaching out by telephone prior to home visits to ensure that those being visited are not experiencing any symptoms related to COVID-19. As always, please ensure to adhere to all CMS guidelines.
Hours of Operation:
Presently, all call centers will be operating business as usual. As our country continues to prepare and execute safety measures, we will continue to evaluate business processes that will ensure the safety of all partners.
We encourage you to reference the Centers for Disease Control and Prevention (CDC) website as well as local government guidance for current updates.
Further, ensure to use the following precautionary measures to support a safe and healthy environment:
- Thorough handwashing with soap and water for at least 20 seconds — hand hygiene is the most effective method to control the spread of many viral illnesses.
- Using alcohol-based (containing at least 60 percent) hand sanitizer.
- Covering your mouth when you cough or sneeze by coughing and sneezing into a tissue and then disposing of the tissue in a wastebasket.
- Thoroughly cleaning surfaces that may be contaminated.
- Avoiding shaking hands and close contact with people who are sick.
We appreciate your cooperation and support in serving our members and communities in this time of need and uncertainty. As the situation evolves, please know that additional measures will be taken with a local-oriented approach, and we will continue to ensure our employees and partners are supported and safe.
As always, thank you for all that you do to transform the health of our communities and your dedication to our underserved and vulnerable populations. You are making a difference and you are relied upon more than you may realize.
For more information, contact a Pinnacle Representative today at 1-(800)-772-6881 x7731 or email email@example.com.