Transition Fills
Prior Auth vs Exception Cases
Parts of Medicare
Rejection Codes
Med-D Basics
100
A medication can have a transition fill loaded these many times..
What is one time?
100
TPAs and Step Therapy
What is Prior Authorization case?
100
Covers Outpatient Medication
What is Medicare Part D?
100
TPA or Step Therapy
What is rejection code 75-Prior Authorization Required?
100
Standard TAT
What is 72 hours
200
Transition Fills are loaded here
What is ESD?
200
FCR and quantity cases
What are Exception cases?
200
Hospitalization, skilled nursing facilities, hospice
What is Medicare Part A?
200
MEqD, QDU, QPDE
What is 76 - Plan Limit Exceeded?
200
Urgent TAT
What is 24 hours
300
Can be filled for a 90 day supply..
What is an LTC Transition Supply?
300
Sets ADT
What are Prior Authorization cases?
300
Doctors visits, durable medical equipment
What is Medicare Part B?
300
FCR/Closed Formulary
What is MR - Closed Formulary?
300
Part D covers
What is Outpatient Medication?
400
Can be filled for a 7 day supply...
What is Non-LTC Emergency Transition Extension?
400
Sets the PII..
What are Exception Cases?
400
Provides all of the services of Parts A and B.
What is Medicare Part C?
400
Hospice
What is 75 - Prior Authorization required w/ secondary A3 rejection?
400
This identifies a Med-D account is ESD?
What is the Medicare Flag?
500
You must document here after loading a transition supply..
What is ESD and C360?
500
This is the only type of case that can have the timer reset by an UMP
What is an Exception Case?
500
Medicare Part C is usually referred to as this..
What is Medicare Advantage?
500
ESRD
What is What is 75 - Prior Authorization required w/ secondary A4 rejection?
500
Deductible, Initial, Coverage Gap, Catastrophic
What are the 4 benefit stages of Med-D?
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