At what age must a parent have HIPAA Authorization on a dependents account in order to access any information?
13
100
If a member wants a list of their drug costs for tax purposes what information would you send them? Bonus: Name the other 3 things we can mail from this sharepoint.
RX History from share point Invoice, Statement, Re-Order Form
100
What are the requirements for a member to be Ship&Bill eligible, and what is the maximum allowed?
No balance past ten days, no cc on file, previous payment history, 100> advocate 300> lead 300< supervisor
100
Aside from potential duplicate accounts, what other reasons could cause a medication to not show up in a member's Medicine Cabinet?
Paid cash price, Entered Status
100
How can you tell if a member has LIS applied to their accounts?
LIS listed in both Member Info and Member Demographics
200
Name and Date of birth are required for Authentication, name 3 options for the third piece? Bonus List them all.
Phone #, zip code, address, rx number, account #, member id #, order #,
200
List all of our accepted payment methods in the correct order.
CC On file, CC One time, ACH, Mailed Check, Ship&Bill
200
What are the qualifications for a PSC to be MCR eligible? Bonus: Within how many days must the script be filled in order for you to receive payout?
Brand New Script, Hasn’t been filled by us in 180 days, Bonus: 30 days
200
At what age must a member register and create their own account on Optumrx.com?
13
200
What is the difference between PDP and MAPD plans?
PDP is drug only, MAPD includes Part B benefits
300
If a member calls and wishes to contact the Privacy office, what two contact methods may you provide the member?
Phone # and Address
300
If a member wants you to tell them details about the payment history on their account where do you go?
Zoom Form, Member Account Details
300
A member wants to return a medication because she got generic instead of brand who do you contact?
Consulting RPH
300
Name the 5 different web tasks. Bonus give a statement for when you would use it.
Cust Svc Web: Registration- registration fails, Log-in assistance- log in fails, Inquiries-never (when ask questions), Errors- placing order, price checks etc, Caregiver- set up, dependants etc.
300
Name the 4 Medicare Part D phases in the correct order. Bonus: Name the accumulated amounts to meet to enter each next phase.
How can you tell if a member will pay the standard Coverage Gap price or a different rate?
Copay Tiers, Coverage Gap says: Full Coverage/Tier1 and 2/etc.
500
If someone calls in on behalf of another member, what information must be authenticated before we proceed with the call?
Member’s name, DOB, one other piece, Caller’s name, presence of HIPAA task, caller’s zip or phone
500
When processing payment for multiple closed orders, what is your process?
Payment to Account, create Accounting AR Update Task
500
The member calls in and says they are worried because they haven’t received their medications yet. What is the first thing you must check to see if their order is shipping correctly? Bonus: How long must the order have been in transit before a resend will be approved?
Ship To Address, 10 postal days
500
What circumstance when signing up for OptumRX.com requires a member to set up security questions?
shared email with established account holder
500
When a medication goes from one coverage phase into the next this is called a ___? Bonus: Name the different types.
Cross over claim: Deductible-ICP, ICP- Coverage Gap, Coverage Gap-Catastrophic