Atorvastatin
A concerned member who is locked out of their account is trying to reorder their prescriptions.
A.) Advise the caller you are going to unlock their account. Utilize CSR Password Reset to unlock their account.
b) Advise the caller to login and click on “Forgot Password.” Utilize Mentor document: Member Username and Password Issues.
c) Advise the caller you will need to escalate this incident to security. Utilize Mentor document: Escalate an Incident to Security
A.) Advise the caller you are going to unlock their account. Utilize CSR Password Reset to unlock their account.
What is the difference between regular and expedited mail?
a) Expedited mail only shortens the shipping time after orders have left the mail order facility.
b) Expedited mail shortens the time it takes to process orders.
c) There is no difference between the two
a) Expedited mail only shortens the shipping time after orders have left the mail order facility.
7) Members can choose to enroll in which Humana stand-alone prescription drug plans?
a) Value, Basic, or Premier
b) Preferred, Custom, or Elite
c) Enhanced, Standard, or Basic
a) Value, Basic, or Premier
When researching a denied drug claim in RxNova Call Connect, you find error code “082” listed under the Errors & Messages panel, what does this mean?
a) The medication is a CMS excluded drug.
b) The member is attempting to get an early refill.
c) Pre-authorization is required through HCPR
c) Pre-authorization is required through HCPR
What order information must be verified with the caller before releasing the call?
a) Member cost share
b) Shipping address and member cost share
c) Amount of current supply
d) Shipping address, cost share, and amount of current supply
d) Shipping address, cost share, and amount of current supply
If the member does not have enough supply on hand to last until delivery, follow the Missing Rx process to obtain a refill locally if a prescription is not already on file, and ______.
a) Put a rush on the pending order.
b) Perform a mail order override.
b) Perform a mail order override.
Humana does not cover replacement of lost, stolen, or damaged medications. However, you (the advocate) can offer members some helpful suggestions. Which one of the following is NOT an appropriate suggestion in this case?
A) Contact their doctor or manufacturer to see if they have/offer free samples
b) Call “211”, a nationwide Help Referral Service for local resources available.
c) Advise the member to file an appeal with the insurance company for a one-time exception.
c) Advise the member to file an appeal with the insurance company for a one-time exception.
According to the Medicare Immunization Coverage Reference guideline, how is the Pneumococcal vaccine covered?
a) Under Medicare Part B
b) Under Medicare Part D
c) HCPR must review to determine B vs. D coverage
a) Under Medicare Part B
If, while researching a different denied drug claim, you notice error code “221” is listed in the Errors & Messages panel, what does this mean?
a) The medication is for a drug covered under Part B only.
b) This is a duplicate charge for a claim previously processed.
a) The medication is for a drug covered under Part B only.
A PDP member is traveling across the U.S. to visit family and friends. Can they get their prescriptions filled in any state?
a) Yes, they can use any Humana pharmacy or get a vacation supply before they leave if they have not exhausted their limit.
b) Yes, but they’ll need to use CenterWell Pharmacy Mail Order for a 90-day supply of the prescription.
a) Yes, they can use any Humana pharmacy or get a vacation supply before they leave if they have not exhausted their limit.
When viewing drug pricing results in RxConnect, what indicator represents the best deal for our members?
a) Lowest cost in the Member pays column
b) Lowest cost in the Total cost column
c) Amount corresponding to the green dollar sign
c) Amount corresponding to the green dollar sign
This date must be manually entered when placing CenterWell Pharmacy orders for "Yellow" items with a future Next Fill date.
a) Creation Date
b) Release Date
c) Finished Date
b) Release Date
A member expresses concern over the high copay cost of their prescription that their PCP states is the only effective medication for them. What is the best course of action?
a) Show empathy and advise them this estimate is accurate based on their current plan.
b) Advise the member they can request a tier exception and warm transfer them to HCPR
b) Advise the member they can request a tier exception and warm transfer them to HCPR
What is the only exception that would result in Humana covering a lost or damaged medication?
a) An isolated personal crisis exception.
b) A disaster exception.
c) An exception granted by the pharmacy due to prior authorization delay.
b) A disaster exception
What information do you relay to the caller regarding ordered medication?
a) Type of Rx, Quantity, Next Fill Date, and Day Supply
b) Name, Dosage, Quantity, Day Supply, Next Fill Date and Remaining Refills
b) Name, Dosage, Quantity, Day Supply, Next Fill Date and Remaining Refills
9) Where in CRM is a member’s Low Income Subsidy (LIS) status located?
a) Person Account page – Communication panel
b) Person Account page – Policies section
c) Plan Member page - Eligibility Information section
c) Plan Member page - Eligibility Information section
When addressing access to care issues (where members are unable to obtain their prescriptions when they need them), you must always confirm the member has enough medication to last how long?
a) 24 hours
b) 36 hours
c) 48 hours
c) 48 hours
Where in RxNova Call Connect is a member’s Low Income Subsidy (LIS) status located?
a) Benefits & Eligibility Deductible & Accumulators panel
b) Benefits & Eligibility Part D panel
c) Benefits & Eligibility Dual Coverage panel
b) Benefits & Eligibility Part D panel
When researching prescription drug (Part D) claims, where will you confirm if the covered amount applied towards the member’s deductible?
A.RxNova Call Connect Benefits & Eligibility Detail panel
B) RxNova Call Connect Claim Detail Benefits panel
B) RxNova Call Connect Claim Detail Benefits panel
0)According to the Extra Help/LIS Comparison guideline, if a member’s LIS status shows 1001, what subsidy level is this?
a) Subsidy 1
b) Subsidy 3 and 4
c) The member does not have LI
b) Subsidy 3 and 4
What information can we modify in the member's mail order pharmacy account?
a) Primary phone numbers and email addresses
b) Alternate and Mobile phone numbers only
c) Contact numbers and email addresses
c) Contact numbers and email addresses
When verifying prescription drug (part D) benefits in RxConnect, how will you know if a medication requires prior authorization approval from HCPR?
a) “Prior Authorization”, “B vs D Determination”, or “Step Therapy” appears under the Coverage column
b) “Quantity Limits” appears in the Coverage column
a) “Prior Authorization”, “B vs D Determination”, or “Step Therapy” appears under the Coverage column
How can you tell when a drug claim requiring correction was adjusted and reprocessed in RxNova Desktop?
a) A date is visible in the Adjustment date field.
b) The claim source will always show “DMR Long”.
a) A date is visible in the Adjustment date field.
When verifying prescription drug (Part D) benefits, where will you confirm if the member reached or is nearing their initial stage?
a) Pharmacy Finder
b) CRM
c) RxNova Call Connect
c) RxNova Call Connect
If the indicator under the RxNova Call Connect Dual Coverage panel shows “S”, what does this mean?
a) The member does not have other insurance coverage besides Humana.
b) The member has other insurance (OI) – Humana is secondary.
b) The member has other insurance (OI) – Humana is secondary.