Part D
A list of medications that are covered by the plan
What is a formulary?
Certain Medicare beneficiaries automatically qualify for Extra Help if they:
What is receive full Medicaid coverage, receive help from their state Medicaid program paying for Part B premiums (in a Medicare Savings Program) and receive Supplemental Security Income (SSI) benefits?
I help with submitting a grievance or appeal
What is Appointed Representative?
BEN Code for 90732
What is MED?
A process of collecting information prior to inpatient admissions and performance of selected ambulatory procedures and services.
What is a precertification?
A drug sold by a drug company under a specific name or trademark
What is a Brand Name Drug?
Receives 100%, 75$, 50%, or 25%
What is Level 4?
A communication, oral or written, from a member or member's authorized representative seeking information
What is an inquiry?
Description for 71250
What is CAT SCAN OF CHEST?
An authorization form given by the primary physician for medical care required outside of his office.
What is a referral?
Preferred Brand is Tier __
What is 3?
Copy of member Medicaid card which includes their name and an eligibility date during a month after June of the previous calendar year.
This is an example of.....
What is Best Available Evidence Documentation?
30 day TAT Standard
72 hour TAT Expedited
What is an Appeal?
Zip 28273
POS: Office
Product: MEPPO
Rate System: MCARE
Medicare Rate for 93000
What is $16.36?
The 2 types of referrals a member can recieve
What is consult and consult & treat?
37% Generic
25% Brand
Until TrOOP amount reaches $5,100
This benefit stage is...
What is Coverage Gap?
TRC 118
This enrollment code is for.....
What is Facilitated Enrollment?
A medical request for payment, reimbursement or precertification
What is Organizational Determination?
Anesthesia units for 21501
What is 5?
A web-based application that will house precertification authorizations
What is ATV?
Sometimes covered under Medical (Medicare Part B) and other times under Pharmacy (Medicare Part D)
What is Situational Drugs?
A member calls in and says "I just recieved a blue letter from Aetna can you tell me what this is for?"
This letter was sent to infrom.....
What is The member is currently in a $0 premium plan that will increase for the next year OR the plan will not be available beginning January 1st ?
The AIC requirement is $1630
What is Level 5: Judicial review?
Zip Code 28273
POS: Inpatient
Product: MEHMO
Rate System: MCARE
20% rate for 62000
What is 200.12?
A physician can submit a referral how.
What is paper and electronic?