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
Drug rejects 75 Prior Auth Needed and is a targeted drug. What criteria would you select?
What is PA
Who won the most recent superbowl?
Who are the SEATTLE SEAHAWKS
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 HOT CHICKS
Drug was approved 3/31 for PA criteria for 12 months, but as of 5/1 drug rejects 70 Product Not Covered. What criteria would you select?
What is CE or FE and all applicable programs
What 3 countries were the hosts for the 2026 world cup?
What are Canada, Mexico, USA
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
In Baseball, what is it called when someone is up next to bat?
What is ON DECK
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
What NBA star's nickname is The Black Mamba?
Who is KOBE BRYANT
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
Which athlete has won the most Olympic medals?
Who is MICHAEL PHELPS (with 28 medals)
On the claim transaction page, to open the PA Details what key would you use to Hot Key the PA number?
What is F4