PA
A case appears eligible for auto-effectuation in CORE but cannot be automated and must instead be entered directly into RxCLAIM.
What is a PA that requires manual entry using the PA Entry Macro
What clients are currently in Judi
Who is KS , SEIB, LGHIB,MN
Why is Halloween celebrated on October 31st?
What is because it is the eve of All Saints Day.
What is the first step in Review Outcome?
What is IDENTIFY THE DECISION
What is Primes main fax number for Clinical Review Comm
What is 855-212-8110
Before editing a PA for an incorrect-detailing issue, technicians should first verify that the PA they are about to edit matches this section in CORE.
What is the Effectuation Information section
Which client recently took away the reconsideration review
Who is NJ
In the movie "Adams Family" what is "Thing"?
What is a Hand
What is the last step in Review Outcome for all clients EXCEPT KS, SEIB, LGHIB, MN
What is ENTER EFFECTUATION DETAILS IN CORE
What state was Prime founded in
What is MN
These migrated authorizations should never receive High Dollar detailing because they were implemented from a previous PBM and require a new review under standard processes.
What are PTINEWIMP PAs
What client does not backdate their PAs
Who is CBC, KS
True/False - Is Frankenstein a monster?
What is False - He was the creator (Dr) of the monster.
If a claim is rejecting for HD after entering an authorization in for a RI case, what step would we follow next?
What is LEAVE AS IS
What year was Prime founded
1998
A pharmacy receives Reject 88 DUR Verify/Quantity after the authorization is correctly entered. According to troubleshooting guidance, this reject does not indicate an authorization issue and requires the pharmacy to enter this PA code.
What is Type 00, Number 00000000003
What plans are under the 4 Direct-to-Employer client
Who are AmeriHealth Administrators | Hormel | Sheet Metal | University of Minnesota
This US state produces the most chocolate
What is Pennsylvania (Hershey)
Prior to to clicking Submit on the Review Outcome screen what must be completed for Hemlibra, Hemophilia/Factor VIII, Hepatitis C and Riastap/Fibryga?
What is GET A BUDDY CHECK
What BCBS Plans founded Prime
What is BCBS MN and BCBS NE
CORE auto-effectuates the case, but the authorization lands in OPEN-EFFECTUATIONFAILURE and contains an AUTOMATED TRIAL CLAIM FAILURE message.
What is a case requiring manual troubleshooting
What does LGHIB and SEIB stand for
What is Local Government Health Insurance Board (LGHIB) | State Employees' Insurance Boards (SEIB)
This state grows the most pumpkins
What is Illinois
You are required to check for a lockout for specialty medication whenever entering a prior authorization using Ignore Drg Sts as ___
What is N
Who was the 2nd CEO of Prime
Who is Kenneth Paulus