Drug Plans
What are the 3 stage of pharmacy coverage?
Deductible, Initial Coverage, Catastrophic
What system do advocates use to quote drug benefits?
RxConnect
True of False: Non-covered drugs go to members accumulations
False
What does claim status PWE mean?
Paid with soft errors
What are the 3 ways members can order OTC?
- Phone
- Order Form (Mail)
- Online
What are Humana's 3 PDP plan types?
Basic, Premier, Value
Jan 1st.
Which department handles Tier Exception requests?
HCPR
How many vacation overrides can a member have in a rolling year?
What code do pharmacies use for disaster overrides?
SAC 911911
This program makes it, so a member pays $0 at the POS but receives a monthly bill to split up the cost for expensive medications
Medicare Prescription Payment Plan (MPPP)
What code is used for a pharmacy to do a vacation override?
SCC 003
- No lower cost alternatives
- Already @ the lowest or highest tier
- A drug list exception was approved for the same drug
How long are COB overrides granted for?
30 days
Who does Centerwell pharmacy mail cold pack medications through?
FedEx
Under what tab in Rxnova can you check members accumulations?
Deductibles & Accumulators
What does EOB Aborted mean when it comes to authorizations?
Humana did not receive enough info from the doctor
The insulin for a non-disposable insulin pump is covered under which part of medicare?
Part B
What does claim status HR2 mean?
Humana plan to Humana plan accumulation transfer
What does ALJ stand for in appeals?
Administrative Law Judge
The amount that Humana + the member + and programs the member is on paid is called what?
Total Drug Spend
What does DESU stand for?
Dedicated Eligibility Specialist Unit
Who are Humana's 2 preferred providers of CGM's?
CCS Medical and Edwards Healthcare
What screen in CI we check Rx Other Insurance?
PEOC
What team is responsible for monitoring natural disasters at Humana?
Global Security Fusion Center