1- What is the frequency of the benefits?
This is determined by the plan but generally the benefit is provided monthly.
2- Can the members exceed their benefit during the given period?
Our system is set up to prevent exceeding the benefit amount.
3- Can the member carry forward a balance?
This is a “use it or lose it” benefit.
4- Can a member order multiple times during the same period?
The member can only place one order during the given period.
5- How can the members order their benefits?
Online, fax, phone or mail.
6- Can OTCHS receive metrics regarding member ordering?
Yes, we can tailor reports to meet individual Health Plans requirements.
7- How does OTCHS verify member eligibility?
We upload eligibility files from the plans via secure FTP site and this provides the member eligibility.
8- What kind of eligibility files is OTCHS capable of receiving?
We work with most files: flat files, 834, 5010 etc.
9- How do OTCHS and the Health Plan exchange data?
Via secure FTP sites.
10- How often does OTCHS receive eligibility files?
We can receive daily files but the most common practice is a weekly file.
11- How is the formulary chosen?
We work with the plans CMO and our Purchasing team to determine the formulary.
12- Are the products on the formulary brand or generic?
Either option is available. However, most plans choose generic products because they provide the members with more purchasing power.
13- How often does the formulary change?
Once a year.
14- How quickly are orders processed? Shipped?
Orders are entered into the system within 24-48 hours of receipt. Once entered into the system, they are shipped within 48 hours.
15- How does OTCHS ship packages?
USPS Parcel Post directly to the member’s home.
16- Where can OTCHS ship the benefits?
Anywhere in the United States.