Prior Authorizations
Adjudication
Workflow
Best Practices
Product dispensing
Weekly
100
What is the system we send MOST of our PA's through?
Cover My Meds.
100
When running and eligibility check what is one piece of information that Enterprise does not always add?
Zip Code
100
What are the 4 pieces of information we need to add an insurance?
BIN, PCN, Group, ID
100
If you are not able to make your shift what do you do?
See if someone can cover or call into the store/Front end a minimum of 2 hours before shift starts
100
After Counting a Warfarin script and the bottle is empty what do you do with it?
Throw it in the P-Listed waste bin.
100
When would you COB MNY Medicaid and Medicare part D?
Never
200
How many days do we try for a PA?
7 days
200
Where do you go to check if a patient has a deductible?
Click "Claim Detail">"Response Pricing"> scroll down.
200
If a Patient has multiple scripts, another person picking up for them, has difficulty getting to the store, ETC. what is one service we can offer them?
Home Delivery
200
When your day supply is 12.5 what is the day supply you Data Enter?
12
200
When opening a new bottle what 2 things should you do every time?
Remove all the aluminum foil and mark with a RED X
200
If something rejects from Central Fill what do you do in data?
Hit the "Dispense order locally" button.
300
If a script is going through no-fault or COMP how do we start the PA?
Call the phone number listed.
300
If this script is a non-control what is our next step?
Click on the "Manage Claims" and adjust your DISPENSE QUANTITY AND day supply to 30 days or under based on the medication.
300
Double Jeopardy!
What is the company goal for accuracy and where can you find your weekly percentage?
93% on the wall across from Drive Through
What is the expected output for Data Entry in an 8 hour shift?
300
When there is downtime list at least 3 things you can do.
Data, Adjudication, Contact Manager, RTS, learnings, bin walks, bay walks
300
When counting a NIOSH medication what are the proper precautions we should be taking?
Wear gloves and count on a designated tray.
300
If a patient wants a MES report sent through the mail what do you do?
Use the 1010 DATA forms link on the homepage and fill out the MES request form.
400
If a script falls back into workflow within a few minutes of auto-resubmitting a PA where should we look?
Check to see the script status with the CMM info button.
400
When we get a rejection stating, "prescriber not enrolled in Medicaid", what do we do?
Go to LexisNexis and search for the MD, if it states "Student in Organized health" you can place the student override in Additional Information. If the MD is not a student or is not a NY prescriber the script will have to be written by an MD that is enrolled in Medicaid, or they will have to pay through a discount card.
400
When you're on Release to Patient what are 4 things you should be confirming with EVERY transaction
Pt name, Address, DOB, # of scripts.
400
Double Jeopardy!
When you receive a HIPAA form what do you do with it?
You put it in an intercompany mail envelope and send it to the Legal department.
What forms do we scan in store and where?
400
When something is out of stock what is our next step?
Text the PT, check to see if there is another NDC available, check to see if it can go to CF, if it can't send it to FOA for 3PM
400
Double Jeopardy!
When someone comes in with No-Fault paperwork what information do you need?
Auto claim #, Auto insurance company name, NYS AOB form
What information do you need if someone comes in with Workers Comp paperwork?
500
After 7 days what should we do with a PA?
Check the "info" button, run the claim for that date of service, text the PT unsuccessful, and profile script
500
What is this rejection saying?
The script is not covered by INS at the retail level - The patient has to use Mail Order
500
If you see this in inbound what should you do?
Add it in as a new-RX, do the Data Entry for the script with the MD being Jeremy Cushman, and profile.
500
Double Jeopardy!
If a patient on Medicare part D comes in and their copay is over $500 what is one solution you can offer them?
Hint: Adjudication will trigger this rejection.
M3P
What does M3P stand for?
500
Before you perform a 2 NDC what should you check in the system?
Both NDCs are covered by INS
500
If we get a reject for 21 days on a GLP-1 what do we do.
Check the last date from when they got it and Auto-Resubmit for 22 days out. do not start a PA
600
What information is needed for a vacation override?
Date they are leaving, Where they are going, How long they will be gone for, and if they are leaving the country.
600
If you see this rejection in the response message what are your next steps?
Option 1) See if the patient has paid this before Option 2) contact the patient, and send to update status for 3 days out
600
Double Jeopardy!
If a script is in sold status and we need to adjust the billing what process do we use?
BAR
What does BAR stand for?
If its a $0 refund do you need a form?
600
What are the times we set things for in workflow?
4 AM - Specific NDC
9 AM - Contact INS in AM
1 PM - Refill too soon
2 PM - Shingrix second dose
3 PM - FOA
3:33 PM - RPH issue
9 PM - Patient or insurance issue
10 PM - Prior Authorization.
600
What are the steps in the 2 NDC process after confirming coverage and inventory?
create a partial fill for the non-preferred, fill the script and cash out the first part, decline the completion fill from FOA, reselect for the other NDC and fill the script.
600
Double Jeopardy!
A script for Zolpidem 10 MG adjudicates for a refill too soon for 3/15 and the RX has an earliest fill date of 3/16 what text message would you send?
"Refill too soon"
What do you do after you text the patient?