Just The Essentials
This is the standard co-pay listed for Florida Healthy Kids members.
What is $5.00?
This program helps resolve prescription reimbursement rejections after self-help options have failed.
What is the Ombudsman Program?
CCP occupies this position when other insurance is available.
What is payer of last resort?
Prior authorization requests from providers may be accepted only by this method.
What is fax?
This reject code means “Pharmacy Not Contracted with Plan on Date of Service.”
What is NCPDP reject code 40?
This is the maximum standard days’ supply per prescription.
What is 31 days?
Early refills are this type of event under the Hernandez Settlement Agreement.
What is a non-HSA event?
This Other Coverage Code is used when the primary payer collected a positive amount.
What is OCC 2?
This status is not allowed for PA requests under this plan.
What is pending?
This reject code indicates a pharmacy is not contracted in the specialty network.
What is G6?
Dependents use this type of identification number.
What is their own ID?
After hours, agents collect the best callback number and this other detail for an Ombudsman escalation.
What is the best time for the pharmacist to return the call?
This Other Coverage Code applies when the primary coverage is active but pays nothing.
What is OCC 4?
Reconsideration requests must be received within this many days of the initial PA denial.
What is 60 days?
There are this many lock-in restrictions listed for the plan.
What are none?
A newborn may use this person’s ID for the first three days after birth.
Who is the mother?
A supervisor should make every effort to resolve a complaint within this period.
What is 24 hours?
This reject code may occur when OCC 0 or OCC 1 is submitted even though the member record has TPL.
What is NCPDP reject code 41?
The early-refill tolerance for non-controlled medications is this percentage.
What is 80%?
A member who urgently needs a specialty medication may receive a one-time courtesy override for this length.
What is one month (30 days)?
FirstRx matches eligibility using the full date of birth, gender, and this portion of the last name.
What are the first three letters?
If a complaint remains unresolved after 24 hours, this organization must be notified so the grievance process can begin.
What is Community Care Plan (CCP)?
Unlike many COB processes, CCP’s generic COB process does not require a match on this field.
What is the Other Payer ID?
The early-refill tolerance for controlled medications is this percentage.
What is 90%?
When Prime Specialty Pharmacy requests an approved all-drugs specialty opt-out, the authorization lasts this long.
What is three years?