Appendix_B-Sample_Work_Flow.pdf

Appendix B – RFP #HHS-ASPR-16-100-SOL-00006 EPAP Long Term Requirement

EPAP WORK FLOW PROCESS

ACTIVATION

1. ASPR Contracting Officer Activation Tasks Contracting Officer activates EPAP Program by:

1.1. Creating an EPAP Activation Task Order.

1.2. Emailing the EPAP Activation Task Order to Contractor

1.3. Calling Contractor verbally presenting the details of the Activation Task Order.

1.3.1. If no answer, leave a summary message of the Activation Task Order.

1.3.2. If the Contractor does not return the Activation call within 15 minutes, call the

Secondary Contractor Coordinator.

2. Contractor Activation Tasks Upon receiving the EPAP Event Activation Task Order, the Contractor initializes the program.

3. Contractor Activation Tasks The Contractor will initialize the program by:

3.1. Compiling the list of eligible zip codes for the event, based on the geographical specifications provided with the Task Order.

3.2. Assembling the Activation Packet with Eligibility Sheet, Public and the list of eligible zip codes.

3.3. Notifying the Call Center of Activation:

3.3.1. Emailing the Call Center the Activation Packet.

3.3.2. Emailing the Call Center the eligible zip codes for the event.

3.3.3. Calling the Call Center and verbally presenting the details of the Activation

Packet.

4. Contractor Activation Tasks Upon receiving the EPAP Event Activation Packet, the Call Center will:

4.1. Fax the Activation Packet to Network Providers (Pharmacies)

4.2. Email the Activation Packet to Network Providers (Pharmacies)

4.3. Notify the ASPR COR that Network Providers (Pharmacies) have been notified.

4.4. Begin processing claims and claim payment

Once the EPAP Event is Active:

5. EPAP Activation Reporting:

5.1. One (1) hour after the EPAP Activation Task Order was received, the Contractor will email a status update regarding the EPAP Activation Task Order

5.2. Included in the status update will be:

Appendix B – RFP #HHS-ASPR-16-100-SOL-00006 EPAP Long Term Requirement

5.2.1. Summary count on the # of provider calls received to date

5.2.2. Summary count on the # of member calls received to date

5.2.3. Summary count on the # of member claims received to date

5.2.4. Summary dollar value of the claims paid to date

5.3. Repeat the status update (6) six hours after activation.

5.4. Repeat the status update routinely thereafter as requested by the ASPR COR.

6. Process Invoicing

6.1. This process will be scheduled monthly or more often after the EPAP Event is activated.

6.2. Process will include all billable items - for example: activation/deactivation fees, drug costs, dispense fees, call center costs, fax changes and assorted charge order costs.

Supporting documentation will be included with the invoices.

DEACTIVATION

7. ASPR Contracting Officer Deactivation Tasks Contracting Officer de-activates EPAP Program by:

7.1. Creating an EPAP Deactivation Task Order.

7.2. Emailing the EPAP Deactivation Task Order to Contractor

7.3. Calling Contractor verbally presenting the details of the Deactivation Task Order.

8. Contractor Deactivation Tasks Upon receiving the EPAP Event Deactivation Packet, the Call Center will:

8.1. Fax the Deactivation Packet to Network Providers (Pharmacies)

8.2. Email the Deactivation Packet to Network Providers (Pharmacies)

8.3. Notify the ASPR COR that Network Providers (Pharmacies) have been notified.

8.4. Begin final auditing claims report

8.5. Begin closeout claim payments