PRIMARY INFORMATION Shipping Address (if different from primary) Name Ship to: Member ID # Address Home Address City State Zip City State Zip Phone Number Refill # Birth Doctor’s Doctor’s Health Patient’s Name (if applicable) Date M/F Allergies Name Phone # Conditions Please include special instructions you may have to help us process your order: Convenient Home Delivery. Cost-Effective Care. REFILL REMINDER Use our automated line to re-order. 1. Call our toll-free number: 1-866-507-4276 2. Choose OPTION 1 3. Follow the prompts 4. Each label below contains all the information you need to re-order. IF YOU DO NOT HAVE ANY REFILLS: Obtain the new prescription from the doctor and mail that prescription in the enclosed envelope. OR Have the doctor fax the new prescription to us at our toll-free number: 1-866-907-4276. Order form and reply envelope enclosed. Script-Wise has Client Service Specialists available to help you with any questions you may have. Please call toll-free 1-866-507-4276 and choose option 2. Monday - Friday 8 A.M. - 8 P.M., EST Saturday 9 A.M. - 12 P.M., EST Self Spouse Other CONVENIENT CARE Script-Wise Pharmacy is committed to fulfilling all of your home delivery prescription needs. Our dedicated client services specialists are available to assist you with your prescription needs Monday through Friday 8 A.M. - 8 P.M. EST, and Saturday 9 A.M. – 12 noon EST. Call toll-free: 1-866-507-4276 SAFE MEDICATIONS Our registered pharmacists review your prescription order at several stages of the preparation process to ensure safe and effective use of your medications. Pharmacists are available to answer your medication questions and counsel you on use Monday through Friday 9 A.M. - 5 P.M. EST, and Saturday 9 A.M. – 12 noon. Call toll-free: 1-866-507-4276
Transcript
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Convenient Home Delivery. Cost-Effective Care.
REFILL REMINDER Use our automated line to re-order.
1. Call our toll-free number: 1-866-507-42762. Choose OPTION 13. Follow the prompts4. Each label below contains all the information you need to re-order.
IF YOU DO NOT HAVE ANY REFILLS:Obtain the new prescription from the doctor and mail that prescription in the enclosed envelope.
ORHave the doctor fax the new prescription to us at our toll-free number: 1-866-907-4276.
Order form and reply envelope enclosed.
Script-Wise has Client Service Specialists available to help you with any questions you may have.
Please call toll-free 1-866-507-4276 and choose option 2.
Script-Wise Pharmacy is committed to fulfilling all
of your home delivery prescription needs. Our
dedicated client services specialists are available
to assist you with your prescription needs Monday
through Friday 8 A.M. - 8 P.M. EST, and Saturday
9 A.M. – 12 noon EST.
Call toll-free: 1-866-507-4276
SAFE MEDICATIONS
Our registered pharmacists review your
prescription order at several stages of the
preparation process to ensure safe and effective
use of your medications. Pharmacists are available
to answer your medication questions and counsel
you on use Monday through Friday 9 A.M. - 5 P.M.
EST, and Saturday 9 A.M. – 12 noon.
Call toll-free: 1-866-507-4276
This bottle cap is BOTH child proof and EZ-off
The bottle is shipped as child-proof to reduce spillage in shipping and for the safety of children.
To convert the cap to EZ-off:1. Remove the child-proof cap from the bottle by pushing down and turning.2. Once removed, push firmly downward on the top and center of the child-proof cap with both thumbs.3. Listen for a loud click.4. The cap is now EZ-off.
If you tighten the cap too much, it will return to child-proof.
UPON RECEIPT, PLEASE...
Check the contents of the package.
Make sure the product is damage free.
If you have questions or problems regarding these
medications, call us immediately at 1-866-507-4276.
Please notify us with any changes in your
personal information, such as:
name
address
billing information
Why should I use a Generic Medication
Generic drugs are Federal Drug Administration
(FDA) approved chemical equivalents of their brand
drug counterparts. You should strongly consider a
generic drug if the brand drug you use is available in
a generic equivalent form.
Script-Wise pharmacy will dispense an FDA approved
generic equivalent whenever available if permitted
by your prescriber and allowable by law.
A pharmacist is available during normal business
hours to answer questions regarding the use of
generic medications.
•
•
•
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How do I place an order or order refills?
1. By mail: Complete the enrollment form and patient
profile provided; detach and fold the form towards
the envelope; mail to Script-Wise Pharmacy using
the postage paid envelope provided.
2. By automated phone-line: Call our toll-free refill
order line at 1-866-507-4276, option 1; 24 hours a
day, 7 days a week.
3. By phone representative: Call and speak with
a Client Services Specialist at our toll-free number
1-866-507-4276, option 2.
When will I receive my order?You will receive your order within 10-14 days. We
recommend patients have at least a 14 day supply
on hand before placing their order request.
Primary Information:
____________________________________Participant’s Name
____________________________________Participant’s Member ID #
____________________________________City State Zip
____________________________________Phone Number
Total prescriptions included with this order:
Payment Information: I have enclosed my check or money order made payable to Script-Wise Pharmacy. I have no co-pay under my plan. Please bill my credit card. Visa MasterCard
____________________________________Card Number Expiration Date
____________________________________Total Amount Enclosed Date
I hereby certify that the information on this form is correct. I understand that generic drugs will be dispensed in all cases where legally permissible and medically appropriate.
Get your Wound Closure CEUs !!Learn about The Provant® Wound Closure System ...sends signals into the wound bed to grow and divide cells much faster than standard treatment alone.To learn more, go to: www.progressive-medical.com/13764.cfm
A One Credit, NO COST CEU Program; Accredited for Nurses, Case Managers and Adjusters.
What:
When:
Where:
Progressive Thinking. Powerful Solutions.
Zurich Case Manager Conference
September 29, 20053:15-4:15 P.M. EST
Hilton Garden Inn1501 Lake Hearn DriveAtlanta, GA 30319
RxBin: 600471 RxGroup: EMGE ID #: Use Member’s SSN Person Code: 000 EGIG Test PatientEffective Date: 9/1/2005
Enclosed is your prescription card for all your workers’ compensation pharmacy needs. Please care for this card as you would any other health care benefit card.
YOUR CARD
IS ACTIVE
AND READY TO
PRESENT AT THE
PHARMACY.
KE
Y TA
G
RxBin: 600471 RxGroup: EMGE ID#: 343434343 Person Code: 000 EGIG Test Patient Effective Date: 9/1/2005
Workers’ CompensationPrescription Drug Card
Claims Information: 1-888-908-MEDS
For claim submission issues, priorauthorization issues, or claim rejections,please contact Progressive Medical, Inc.at 1-888-908-MEDS.
Contact Progressive Medical Customer Servicefor medication authorization and prescriptioncard questions at 1-888-908-MEDS.
For additional pharmacies in your area, please visit our website at: www.progressive-medical.com.Select the Total Pharmacy Management option, then select the Pharmacy Locator. Enter your City, State, or Zip Code and click the Locator button. You will see a listing of all participating pharmacies within your specified area.
Through Progressive Medicalʼs exclusive national network of 4,500 providers, every eligible injured party receives immediate, personalized care.
Eligible injured parties are monitored throughout their recovery process, resulting in reduced expenditures, less paperwork and fewer hassles.
Progressive Medical offers one-stop, easy ordering. Simply call us toll-free at 1-800-777-3574, weʼll handle the rest.
• Coordination of all services • Confirmation of equipment deliveries • No front-line voicemail • Same day order processing • Customer service 24 hours a day, 7 days a week • Electronic report processing • Customized cost savings reports • Patient progress notes
Progressive Medicalʼs Client Service Specialists are trained over a 3-4 week period on the following job responsibilities:
Our standard hours of operation are Monday through Friday, 8:00A.M. to 8:00P.M. EST. Through our “on-call” service, we can take care of your eligible injured parties ̓needs 24 hours a day, 7 days a week.
Quality Assurance File Review
• The Quality Assurance staff reviews 20% of each service departmentʼs new referrals.• Files are reviewed to verify all requirements and criteria were met.• Managers review the monthly file reviews for any discrepancies.• The Quality Assurance staff completes a File Review Correction Form for any errors. The Client Service Specialists is given 48 hours to correct their error and return the File Review Correction Form to the Quality Assurance staff.• Scores are recorded on a monthly spreadsheet by department.
Medical Equipment and Supplies Health Services
Compliment and Complaint Documentation
When a compliment or complaint is received, the department manager or regional sales manager completes the appropriate form. Once completed the form is sent to the Quality Assurance Manager. The compliment/complaint form is then routed to the appropriate personnel. The department manager and regional sales manager work together to resolve and follow-up on any concerns. The compliments and complaints are tracked and analyzed on a monthly basis
• An electronic order quote is added to the eligible injured parties file.• After the delivery has been received, the quote is released to the Accounting Department• The billing file is reviewed.• If all the information is correct, the invoice is released to print.• Invoices are printed on a daily basis. The document may be a HCFA 1500, a Progressive Medical standard invoice or a state specific form.• Printed invoices are again reviewed before mailing.• Invoices are mailed/shipped on a daily basis using USPS 1st class, USPS Priority Mail or UPS Next Day Air.
Call Recording
15 Client Service Specialists are randomly recorded on a daily basis. Call reviews are scheduled monthly with the Client Service Specialist to review each monthʼs calls. This step is to ensure our customer service is meeting and exceeding our clients ̓expectations.
Calls are reviewed and scored based on the following criteria: • Greeting • Depth of knowledge of department and company • Thoroughness of information given • Callerʼs questions were answered • Courteous, helpful, professional service • Cross referral was initiated
Realizing Cost Savings
Medical has enabled you to receive? Progressive Medical provides our clients with the tools to make their job easier. One way is through customized cost containment reports. We offer these reports in several different formats; below are a few of the detailed reports we offer: • Corporate Cost Containment Summary • Corporate Referral Activity • Branch Referral Activity • Office Summary by Employer • Detailed Cost Containment by Referral Source • Detailed Cost Containment by Item
Medical Equipment and SuppliesTotal Pharmacy Management
Health Services/Ancillary ServicesHome Health Care/Infusion Therapy
Medical Transportation and TranslationRadiology Diagnostic Services
REALIZE YOUR UNLIMITEDPOTENTIAL
Progressive Thinking. Powerful Solutions.
Progressive Medical, Inc. is a reputable and rapidly growing managed care provider dedicated to the coordination of care. We are looking for compassionate individuals to aid in our eligible injured parties’ recovery process. Progressive Medical offers detailed orientation and training programs, a friendly and comfortable team environment and an excellent benefits package; starting from your first day of employment. Generous vacation and sick time is available, in addition to a competitive 401K retirement savings plan. In preparation of new clients and to support the rapid growth we are currently experiencing, we are seeking:
Programmer Analyst Responsible for developing and testing applications used by employees within Progressive Medical; this will entail applications coding, application level testing, system level testing and support of release level testing. Applicant must have a Bachelor’s degree in Computer Information Systems or related field and 3-5 years of software development experience; must have knowledge of and a demonstrated skill level with UNIX systems, Perl, PL/SQL, JAVA and Oracle. This position offers a signing bonus!
Human Resource representatives will be present at the Columbus Dispatch Job Fair, July 27, 2005. An Information Technologies manager will be available from 12:00 p.m. to 4:00 p.m.
Apply immediately online at www.progressive-medical.com or in person at: Progressive Medical, Inc. 543 McCorkle Blvd. Westerville, OH 43082
Only resumes with salary requirements will be considered.Signing bonus provided!
Progressive Medical supports a drug and tobacco free work environment. EOE
Restat Bin # 600471
Group/Carrier # A852
Questions Regarding Billing
1-888-908-MEDS
Employer: American Furniture Warehouse Attention: Robert Panetta, Risk Manager Address: 8820 American Way Englewood, CO 80112 Phone: (720) 873-8612
WORKERS’ COMPENSATION
This form may be presented in person or sent via fax.If this form is completed, no phone call is required.
Patient: Present this form with your prescription(s) to any pharmacy listed on the back of this sheet. In the event that this is a non-payable claim, the below named employee is responsible for payment.
