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PSL Systems Decision Tree - Coggle Diagram
PSL Systems Decision Tree
MEDICAID
For Medicaid Members from CA or SC
Do you need to:
Verify Eligibility?
Locate OHI?
Note: This is a member source system.
Use
CCB
https://callcare.wellpoint.com/ccb-wgs/login.asp
Remember to select
provider care
from the
drop down menu
.
Do you need to:
View & interpret claims?
Perform Claim Overrides?
Verify Pharmacy Lock-Ins?
Use
COS
Remember to ALWAYS TAKE NOTES in COS AFTER EVERY CALL
Do you need to:
Verify Eligibility?
Submit Enrollment Request?
Gather Medicaid State ID (except for CA or SC)?
Gather Medicare Beneficiary ID (MBI)?
Gather Appeals Information?
NOTE: This is a member source system.
Use
COMPASS
in Your PULSE Apps
Do you need to:
Verify Dual Member Medicare Information?
Note: This is a program within CMS.gov
Use
MARX
https://portal.cms.gov/portal/
REMEMBER: Marx is used whether or not the member has a Medicare Part D policy (either Anthem or another carrier)
.
Do you need to:
Find Medicaid Formularies?
Find Pharmacy Lock-In Tickler?
Find Medicaid Benefits?
Use
PHARMTOOL
Do you need to:
Locate Additional Benefits Not Found in PHARMTOOL?
Note: This is the benefit information our CVS partners see.
Use
The Source
Do you need to:
Submit an OHI Removal Request for CCB Members?
Use
FUSE
(Look for
EFUSE
) or
COMPASS
Found in your PULSE apps.
Do you need to:
Verify Appeals Information?
Determine Whether an Appeal Has Been Closed or is Still in Process?
Use
PEGA Next Gen Appeals
Do you need to:
View Member Information NOT FOUND in COS?
View Anthem OHI for Medicaid Member to Verify Whether the Policy Remains Active?
Use
BDS
Do you need to:
View Prior Authorization Details?
View a Denial Letter in Order to Explain to a Member?
Use
PA HUB
Do you need to:
Submit an Issue You Cannot Address?
Examples:
Benefits not applying correctly or the wrong copay was charged.
Use
Rx Tickets
Do you need to:
Find Information on How to Perform a Task?
Use
PSL One Stop Shop
Do you need to:
Find Step-By-Step Instructions?
Find Information You Have Been Unable to Find Anywhere Else?
Use
IGRX Knowledge Management (KM)
Do you need to:
Research a topic because you are stuck?
Use
Knowledge
Library
MEDICARE
COMMERCIAL