Lead Disposition Form

Lead Disposition Form

Please add your Lead Disposition to this page within 24 hours of running the lead.
Agent Name*
Prospect Name*
Blue CrossGlobal / GenerationsNational GeneralHealth Insurance Enrollment Center (from an event or from Agency)HumanaBlue Cross MAC Team LeadsUnitedhealthcareAetnaChristusCommunityCareHarvard Family Physicians
Blue Cross Appointment Request (AR) #
Date lead was run*
Enrolled Blue Cross MAPDEnrolled Global / Generations MAPDEnrolled Blue Cross Med SuppEnrolled Blue Cross PDPEnrolled Humana MAPDEnrolled Humana PDPEnrolled UHC MAPDEnrolled UHC PDPEnrolled Coventry / Aetna MAPDEnrolled Mutual of OmahaEnrolled Aetna Med SuppEnrolled CignaEnrolled other
Provider/s not in networkNot in Service AreaStaying on Current Blue Cross PlanStaying on Current Competitor PlanWants to think about itDrugs not in Formulary
Lead notes
Should be Empty: