Max Quantity
In the denial database in the PA Info tab (located under the physician info and to the right of the drug name dropdown), you type in this max qty info
What is the Requested Qty and the Days Supply?
The only 3 CAS classifications CSR1’s will use
What are “PA Request, “Inquiry-Check Status”, and “ePA Key Code Created”?
This is the amount of time received each month to go into PER
What are 30 minutes?
This is the close option you should choose for Incomplete Info after notating the missing info in your close option notes
What is Send To RPH Queue?
The function you should use when requesting time off within 2 weeks
What is Add an Activity under My Schedule?
This is the close option you would choose for the 1st database
What is RPH Deny (Max Quantity)?
The classification you would select if you did not start a PA on a call and ended up transferring the caller to CSU
What is “Inquiry-Check Status”?
This is the amount of AZSICK we get for the year
What are 40 hours?
This is the close option you should choose for Incomplete Info if the MDO info is missing and there are no matching fields of the MDO info populated in PA Info tab
What is Incomplete Info?
The function you should use when requesting time off over 2 weeks away and within 6 months
What is Time Off Manager?
The PA you add the requested qty into for the criteria
What is the Denial PA?
This should be included in every inquiry note
What is the drug name (or no drug)?
This is the number of Unexcused Absences a rep can have before getting a Level 1 for attendance
What are 4 UA’s?
In this scenario for the HAD drug class (Gelsyn, Gel-One, etc.), you would process the PA as a Continuation of TX. It does not matter how the MDO answers
What do we do if there was a previous PA for both knees and there were paid claims?
The application you should use to track how much PTO and FHOL you have left
What is Workday under Time Off Balance?
The PA you add the RPH approved qty into for the criteria
What is the Approval PA?
You will include this in your inquiry notes if there is a PA on file that you discuss with the caller
What is the PA Status?
This is the number of months you can go over in PER time before it leads to a CAP
What are 3 months?
In this scenario for the HAD drug class (Gelsyn, Gel-One, etc.), you would accept the MDO’s attestation on Init or Cont TX
What do we do if there is no PA or paid claim for a HAD medication within the last 3 years?
The date you should select to view your Time Off Balance in Workday
What is 12/31/2025?
In this scenario, you do not need to open a 2nd database for an approval
What if there is already an approval on file that is NOT expiring within 3 months?
Notes that detail what actions were taken on an inquiry call
What are the Actionable Items?
The number of times a rep can go over in this state is based on a rolling calendar year, and does not refresh in the new year
What is PER?
This is the close option we will select if we notice a MQA member note for opioids
What is Send to RPH Supervisor?
The function you can select within Time Off Manager to check the group allowances for PTO available
What is Time Off Allotments?