Of COURSE I know what I'm doing

[Khana]

I was handling pharmacy support, as usual, on the phones. Pharmacy has a problem with one of our cards, they call us, and we help them fix it. Some pharmacies have difficulties with this type of billing, so our company researched how to submit claims on their systems. Really nice of us, huh? Yep. It's cool.

Walgreens is the culprit here. They've got this REALLY nice system, that they hate for some reason. It's called submit direct link. They can actually Manually update all the claim information, including the exact price they want to submit, with the minimum needed information to go through. And it's not a lot of fields to complete, either. We've got a complete walkthrough on Exactly how to get claims through that system. It's great because no matter what the situation, if they have a hard time, they can use the SDL to just fix it. It's great. You wouldn't believe how many pharmacies would love a system like that, because they're constantly fighting with the computer to "auto-update" the correct fields, and can't manually update hardly anything.

Anyways.

This pharmacy guy calls in, all "I know everything" and all huffy. He's using the SDL, and acting like he knows EXACTLY what needs to be done with the blasted thing. Problem is, he submitted it as a primary insurance... the discount card is supposed to be submitted as secondary. This seriously isn't hard in the SDL thing. They literally click a button that pops up with all their choices on coverage codes. For instance, "0" (which he was submitted) said "primary insurance claim." The code he was supposed to use was "8" which says "claim is billing for a copay." It's pretty common sense.

So, I tell him the claim looks good in all other respects, he just needs to change the coverage code to an 8. He insists that he did so. Yeah. The only pharmacy will a manual submission ability suddenly auto-corrected his claim to the wrong code. No, that's what OTHER pharmacies deal with.

So, I have him fill out the SDL thing again, and tell him, "Now, hit the 'other coverage' button and choose 8, claim is billing for a copay. Then fill out the SDL exactly as you did before, just with that change, and it'll go through."

So, he does. And guess what? It goes through. Without a hitch.

So, then he gets huffy.

Him: "That's what I did last time, and it didn't work. Why didn't it work last time?"

Me: "Last time you submitted it as a primary insurance, so we took the cost off the medication cost rather than the copay. The other coverage code was 0."

Him: "But I submitted it as an 8, exactly like I did this time."

Me: "Perhaps you were having a system issue? The coverage code came through as a 0. You put it in as an 8, and suddenly it worked. Maybe your system was giving you a hard time."

Him: "But I was putting it in repeatedly, it wasn't just a one time thing."

Me: **quickly checks the logs** "Yes, I'm showing repeated submissions with a coverage code of 0. Previously it came through as 0, for whatever reasons perhaps known only to your computer, and this time it came through as an 8, so it paid. The problem has been solved. Is there anything else I can do for you today?"

Him: **sighs** "No, thank you."

**shakes head** There's nothing we can do about what information we RECEIVE. I mean, if the coverage code came through as empty, it wouldn't even get to us at ALL, it would be rejected by... well, rather than getting technical, let's just say it would get stopped halfway between our computers and they'd getting a message that it was an invalid format.

Drives me crazy. He just couldn't admit that he messed up.

Khana

[IT Grunt]

I get this from users all the time. It's like some sort of taboo to own up to the fact that you screwed up. That guy's response is classic. "Well, that's what I DID!" Um, no, because if you had, it would have worked.

Examples:

Guy goes to post activity for product going through the line.

U: "I entered XX for <product spec>, and it said that wasn't correct! How am I supposed to post!?"
IT: "Um, the database says you entered YY. Try again."
U: "I enterrrrrred XX! How can it say YY? Oh well, we'll do it your way.."
*He does it again, entering XX like he's supposed to*
U: "Oh.. it's working now. <click>"

Office user tries to send an email. A note that in our system, auto-lookup for addresses is by last name.

U: "I entered in so and so's name, and it said it couldn't find him!"
IT: "Did you enter it in by last name?"
U: "Of course I did!"
*I enter it in using their last name. Wonder of wonders, it works.*
U: "But that's what I DID!"

Etc, etc, etc.... Makes you wish you could reach through your monitor and strangle them, doesn't it?

[AFpheonix]

In his defense, we don't actually get any good training modules on SDL. We kinda have to feel it out on our own. There also tends to be different plan codes for either submitting the coupon as primary or as secondary. Learned that the hard way, too.

At our store though, we hit print screens while we're on the phone with helpdesks, and add them to our little training notebook that we've made ourselves. I personally did the one for the COB coupons you're talking about.

[earl colby pottinger]

But

You have to admit to a mistake, to learn from it. Those who refuse to admit that they make mistakes never learn and just keep on having problems all the time.

[AFpheonix]

Oh, of course, which is why I always come to the nice helpdesk people with a "hi, I'm an idiot" sort of attitude. It tends to get me pretty far, unless it's medicaid's helpdesk for some reason, and for that one I've had to help multiple agents through basic math so I can get them to help me override a claim.

[Khana]

Oooh, yay, you know Exactly what I'm talking about

Usually, I breathe a sigh of relief whenever I get Walgreens, because we have the SDL walkthrough, and it's soooo nice. I'll often get pharmacists/techs who're like, "Uh oh, you want me to SDL that? I've got no clue how!" and I'm like, "That's not a problem, I can tell you Exactly how to run that!"

And a lot of pharmacies, like Eckerds, they updated their systems recently so None of our data matches theirs. It's a constant guessing game of, "Well it may be called this? Or this? Or this? Um, perhaps the field is in this segment? Some pharmacies call it retail sales field? OI code? Um..." and it's a literal guessing game, especially with techs who don't know the system very well.

I love walgreens, as a pharmacy, because we know EXACTLY how to get the claim through. No guessing game, no maybes, it's sooo nice. Most walgreens callers are cool, too, but it gets on my nerves when they fuss about how terrible SDL is, or when they KNOW how to get it to go through and they're doing something stupid. Like forgetting to put in the group number. HA! Funny. **cries**

I got an Eckerds caller once who used to work at walgreens, and she was fussing about how she missed Walgreens system, especially SDL. I smiled. She couldn't find our program, and was also fussing about how she missed being able to run searches by BIN numbers. They have these silly plan codes. Fortunately, they've updated and can search by BIN numbers now. Took 'em long enough.

Sadly, some reps on our side aren't too bright... fortunately, they can read a step-by-step walkthrough... heh. And we've got cool supervisors who'll override something on a whim. Yay