SPRX
How do you pull a task?
Que - Processing
Sub Que - Insurance Diversion
Get Task
What is People Safe used for?
Running a Test claim - Locate Patients that are apart of Cvs PBM
Verifying insurance - Overrides - COB
Viewing Account Balances - Demographics
Verifying Prior Authorizations - Eligibility
Which tools can be used to send a fax to a MDO?
Specialty Admissions Database
What are the Drugs National Codes assigned by the FDA to identifying drug products marketed in the US?
NDC
Health Maintenance Organization
HMO
When you first pull up an account what should you do?
Check the Alert Type
What steps do you take to view a Prior Authorization in PPS?
Click on Plan Benefit Override - Then click on the View PA Status Button
Which tools can be utilized to find Patient Demographic Data
Enterprise
People Safe
Sprx Demographics Tab
What are the registered trademarked names given to a drug?
Brand Names
Combination of PPO and HMO plans
POS
How do you add a Prior Authorization?
Navigate to the Insurance Screen
Press Edit at the lower right hand side
Select Add New PA
Fill in correct information
Where do you find the MOOP?
By clicking on the Account Balance tab
Which Tools can be used to Create Notes on the Patients account?
BV Note Creator
Sprx Add Note
What has the same chemical formula and active ingredients as a brand name drug and is sold under the chemical name by various manufacturers after the patent has expired?
Generic Drug
The patient pays less if the services are provided within the plans network (in-network)
PPO
Where can you find the Quantity/Day Supply?
On line 11 of the Dispense Mait Screen
What are the ways you can search a PT?
By Member ID
By First Name Last Name and DOB
Which tool can be used to find documents on how to Process Claims, Insurance demographics, and documents on how to run through specific tasks?
The Source
What is Medication that can be dispensed and purchased without a prescription? These drugs are typically not covered by insurance companies.
Over the Counter Medication
More affordable than other plans
HMO
What are two ways to Check Eligibility in SPRx?
Navigating to the teal menu and next to Check Eligibility
Navigating to the Insurance tab and then clicking Check Eligibility
What will happen when Caremark is not the PBM when you search the Member Id in PPS?
Error Message: Beneficiaries were not found
What is a list of drugs covered by a prescription drug plan. Medications on the list are selected based on therapeutic value and costs.
Formularies
The Maximum Dollar amount an insurance company will reimburse during the benefit period (Calander or fiscal year).
Yearly Limit
If the patient obtains a referral from the PCP for a specific provider (even an out of network provider), the plan will pay for a bigger portion of the bill.
POS