PA/PLA?
True or False?
Type of Case
SOP's
Random
100
TPA
What is a PA
100
One of BCBSM and NASCO SOP's is 46.1.1
What is True
100
* This medication is covered under you plan: howecer, it is non-preferred product, your cost may be higher than what you would pay for a preferred medication. *Coverage rules are active for this drug *reason* federal legen drug--select brand hypnotics require prior authorization (???) for patients 18 and over. Zolpidem, estazolam, Flurazepam, Temazepam, Zaleplon covered without prior auth (mco:????): 1800-753-2851
What is FCR
100
Medicare decision tree
What is 5.4
100
37 30 11
What is RAD code when leaving a comment in ESD
200
QD
What is a PLA
200
For Medicare calls the retail pharmicist can answer the clinical criteria questions over the phone.
What is False
200
*Ambien, Edular, Sonata, Lunesta, Rozerem, Silenor are covered for a maximum quantity totaling a 60 day supply in within a rolling 90 day period. If additional quantity is needed, a coverage review may be offered if there is a phone number following this message:(mco:???) 1800-753-2851
What is QD
200
Build/create a case
What is 2.1
200
This is how to tell you are in a Medicare case
What is Medicare Flag
300
FCR
What is a PA
300
When building a case the preferred way is to create the case from a rejected or processed claim.
What is True
300
* This medication requires prior approval.
What is TPA
300
BCBSM & NASCO
What is 46.1.1
300
Member Number, 1st, last name and DOB, Medication name and strength
What is preferred 3 items to use for caller authentication
400
QPDE
What is a PLA
400
A clinical case is for a drug that needs prior authorization
What is True
400
*This medication is covered by your plan's base day and quantity limits *reason* paroxetine hcl * Paroxetine HCL is covered for 31 units or 90 units. For additional quantity a coverage review may be offered if there is a phone number following this message.(mco:???) 1800-935-6103
What is QPDE
400
4.1
What is Phone list
400
RM 10 11
What is RAD code when NOT leaving a comment in ESD
500
If both a PA and PLA is needed this is completed AND approved FIRST!
What is PA
500
Express Scripts handles prior authorizations for HealthNow
What is False
500
*This medication is covered under your plan; however it is a non-preferred product. Your cost may be higher than what you would pay for a preferred medication. Coverage rules are active for this drug *reason* federal legend drug (mco:???) 1800-753-2851 * This medication is covered for a maximum quantity totaling a 60day supply within a rolling 90day period, if additional quantity is needed a coverage review may be offered if there is a phone number following this message. (mco:???) 1800-753-2851
What is FCR and QD
500
5.1 pg 13 ***BONUS*** pg. 12
What is Appeal information *** bonus*** outbound scripting
500
Escalated calls and Assistance
What is reasons to call the RS
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