Close Option Outcomes
The MDO is requesting the amount before PA is needed.
What is Standard Allowance?
This is the start of a new PA.
What is initiation of therapy?
MDO answered incorrect age in the Q-set. My next best step is___.
What is screenshot/edit/re-answer?
I press ___ to get to PA records screen.
I press ___ to get to Claims screen.
What is F16 (Shift+F4) and F10?
Examples of this are member ID, name, DOB, address.
What is PHI/PII?
The MDO is requesting more than PA limit.
What is Send to RPh Queue?
What is continuation of therapy?
If there is conflicting clinical information, select this outcome.
What is Send to RPh Queue?
EEEI stands for PA set for ____ only.
What is generic?
If this is highlighted red, we click on it to review special alerts.
What are Member Notes?
PA on file and not expiring until 6 months from now. MDO submits the same PA request.
What is No PA Needed?
ePA - MDO answers "Yes" to "Has the patient taken this medication within the last 6 months excluding samples" (no show box) and no PA History. This is RESEARCH or MDO ATTESTATION?
What is MDO Attestation?
Drug dropdown and Q-set selection for drug do not match in ePA. I can research _____ to determine the appropriate drug to select.
What is Claims?
For changes in therapy we ___ the original PA record on file so the patient can no longer fill starting today.
What is term?
What is Overseas Address?
MDO is requesting a new medication. There is a PA on file expiring today that is listed on the Appendix in Guidelines / Dual Tx area in Work Instructions.
What is Change in Therapy?
ePA - MDO answers "No" to "Has the patient taken this medication within the last 6 months excluding samples" (RESEARCH ONLY show box) and there IS PA History in past 6 months. What is my next best step?
Which type of GPI(s) approves multiple strengths and/or dosage forms?
What is a wildcard GPI and GPI List?
For OPIOIDS Q-set, MDO answered "no" to any opioid therapy in past 180 days, there is a RESEARCH show box to research paid claims, claims indicate a paid claim today, my next best step is ___.
What is edit/re-answer Q-set?
MDO is switching from a non-preferred drug, to a preferred drug. The request meets criteria.
What is Med Ex Drug Change Approval?
ePA - MDO answers "Yes" to "Has the patient taken this medication within the last 6 months excluding samples" ("If the caller is unsure" show box) and no PA History. This is my next best step.
What is take MDO attestation and continue processing PA?
If Activities tab indicates EPA Transaction "conflicting PAC" this is the Close Option outcome to select.
While in a claim, I can put my cursor under the ID number above the drug name and press ___ to see the full drug name.
What is F4?
When we get a compound request, we must verify if the compound ingredient(s) are rejecting for _____ or ______.