FOLLOW THE PROCESS
If PA in Place was approved for 6 months and expires within 60 days, what type of review is needed?
What is PROACTIVE REVIEW
"I see dead people"
What is THE SIXTH SENSE
A drug rejects 75 Prior Auth Needed and this is a targeted drug- what criteria would you select?
What is PA
This Supervisor's first job was Trail Guide on horseback "took guided rides for boys/girls clubs/scouts, as well as tourist groups."
Who is Barbara H
In RXCLAIMS, when you look up the member what number do you use to display the member detail page?
What is 5
PA in place until 12/24/26 for PA, but claim is rejecting 76 at pharmacy due to pharmacy running incorrectly. Provider is not asking over QL- what criteria should be selected ?
What is NCR PA IN PLACE UNTIL 12/24/2026
"It's me, Jessica"
What is THE HOT CHICK
Drug was approved 3/31 for PA criteria for 12 months, but as of 5/1 the drug rejects 70 Product Not Covered and is still targeted for PA program. What criteria would you select?
What is CE or FE and all applicable programs
This Supervisor's first job was at Walmart as a Cart Pusher
Who is Manny A
In RXCLAIMS, what key do you hit to display the claims ran at the pharmacy?
What is F10
If unable to verify requested drug during outreach, what is the next step?
What is WITHDRAW AS UNABLE TO VERIFY REQUESTED DRUG
"There's no crying in baseball "
What is a LEAGUE OF THEIR OWN
Request is for 4 pens per 28 days, plan QL is for 2 pens per 28 days AND there is a PA in PLACE for another 4 months for up to 2 pens per 28 days what criteria should be selected?
What is QL
This Supervisor's first job was at Hardee's- "morning shift! slinging the biscuits"
Who is Pam S
To run a manual test claim from a claim transaction detail page what keys would you hit?
What is SHIFT+F11
CE was previously approved but PA denied for an FL Blue FI member, case was closed 6/1, you get an appeal for the PA portion- what would you select when withdrawing case?
What is NON-DELEGATED APPEAL
"Show me the money!"
What is JERRY MAGURIE
Request is for Saxenda for a HCSC member that is taking it for weightloss, with reject message ANTI-OBESITY MEDICATION NOT COVERED what criteria would you select?
What is BE
This Supervisor's first job was a place called The Cookie Cart- "baking cookies downstairs and building computers upstairs"
Who is Kita R
To manually add a PA from the claim transaction page what keys to you hit?
What is SHIFT+F10
For RI, if the drug is on the RI Exception list, is there a Courtesy PA needed?
What is NO
" Welcome to the party pal"
What is DIE HARD
Request date is 6/1/2026
Claim is rejecting 70
PA Dates: 6/01/25 - 7/01/26
Program Types: PAQL/GF6/CS/ what kind of review is needed?
What is CE/PA
This Supervisor's first job was at a Warner Brother's Studio Store
Who is Patrick S
On the claim transaction page, to open the PA Details what key would you use to Hot Key the PA number?
What is F4