HBS FUNCTIONS
THE P FUNCTION DOES THIS.
PATIENT LOOK, NAME OR HBS#
WHAT IS THE PATHWAY TO GET TO CUSTOMER SEARCH SCREEN IN SPARCS?
PM> PHARM OPS> PT PHARMACY CALL> NEW CALL
WHAT IS ADAP?
AID DRUG ASSISTANCE PROGRAM
A PROGRAM FUNDED AT THE STATE LEVEL FOR PTS WITH A QUALIFYING INCOME AND DIAGNOSIS TO RECEIVE FUNDING FOR AIDS/HIV MEDS.
WHEN COMPLETING A RFG ON AN INBOUND CALL WHAT CAN WE USE TO VERIFY HIPAA?
3 IDENTIFIERS: PTS FULL NAME FIRST AND LAST,
PTS FULL DOB
AN ADDITIONAL IDENTIFIER:
ZIP CODE, POLICY #, TEL #, DRUG NAME OR RX # FOR ONE OF THE MEDS WE HAVE ON FILE
WHAT IS CYF?
CYSTIC FIBROSIS
PATIENT INFORMATION: SIG REQ, DNF CODES ICD CALL PT.
HOW CAN YOU BRING UP A MBRS ACCT IN SPARCS FROM THE CUSTOMER SEARCH SCREEN?
NAME, ACCT #, PHONE NUMBER, RX NUMBER.
WHAT IS AN EFFECTIVE DATE?
THE DATE ON WHICH INS COVERAGE UNDER THE SPECIFIED POLICY BEGINS A MEMBER IS NOT COVERED UNDER THE INSURANCE UNTIL THIS DATE.
WHAT PROGRAM IS USED TO COMPLETE A RFG?
SPARCS
WHAT IS HGD?
HUMAN GROWTH DISORDER
WHEN YOU SEE A PRESCRIPTION WITH A "U" NEXT TO IT WHAT DOES IT MEAN AND WHAT DO YOU HAVE TO DO BEFORE DOWNLOADING.
THE RX IS UNVERIFIED, THE RX NEES TO BE APPROVED BY AN RPH.
HOW DO YOU LOOK TO SEE IF AN RX HAS BEEN RECEIVED IN SPARCS?
PM>PHARM OPS> PRESCRIPTIONS>PRESCRIPTION ENTRY HISTORY.
WHAT IS ECS?
ELECTRONIC CLAIM SUBMISSION - A PROCESS IN WHICH A PRESCRIPTION DRUG CLAIM IS SUBMITTED ON LINE.
WHEN SPEAKING WITH A PT WHAT IS THE FIRST THING BESIDES HIPAA SHOULD WE ASK AND VALIDATE WHEN COMPLETING A RFG?
ALWAYS VALIDATE THE BEST CONTACT # WITH EACH INTERACTION, ASK THE "QTY ON HAND" FOR EA MED REGARDLESS OF INSURANCE PLAN OR SITE.
PULMONARY ARTERIAL HYPERTENSION
WHAT DOES THE OH FUNCTION MEAN?
PLACES RX ON HOLD AND CAN BE USED TO REMOVE A HOLD ON AN RX.
WHICH HOT BUTTON ON THE CALL DASHBOARD IS USED TO INITIATE A REFILL GUIDE?
REFILL GUIDE
WHAT IS AN EOB?
EXPLANATION OF BENEFITS: THIS IS A DOCUMENT FROM THE INSURANCE COMPANY PROVIDING A WRITTEN EXPLANATION TO A CLAIM INCLUDING THE DOS, THE PROVIDER, THE REIMBURSEMENT LEVEL, ANY APPLIED DEDUCT. AMTS, COPAY/COINSURANCE AMTS THAT THE MEMBER IS RESPONSIBLE FOR AND ANY OTHER PERTINENT INFO.
IF WE NEED TO ADD A COPAY CARD WHILE PROCESSING A RFG, WHICH SCREEN WOULD WE UPDATE THE COPAY CARD INFO ON?
BG SUMMARY
WHAT IS CCC?
ONCOLOGY
WHAT DOES THE CMT FUNCTION IN HBS DO?
USED TO DISPLAY DAY SUPPLY OF RX.
AFTER COMPLETING A REFILL GUIDE, WHICH HOT BUTTON O N THE CALL DASHBOARD IS USED TO UPDATE A WORKLIST EX: PA EXPIRED, REFILL TOO SOON
REFILL PATIENT WORKLIST.
WHAT IS A NEEDS-BASED COPAY CARD?
A NEEDS BASED COPAY PROGRAM IS ONE THAT REQ'S THE MBR/PT TO PROVIDE FINANCIAL INFORMATION IN ORDER TO QUALIFY FOR THE PROGRAM.
WHEN COMPLETING A RFG WHEN SUMMARIZING THE ORDER WHAT MUST THE SUMMARY ALWAYS INCLUDE?
DRUG NAME, DRUG STRENGTH, DOSAGE FORM, QTY, D/S, DELIVERY ADDRESS, DELIVERY DATE, SHIPPING ON ICE, SIG REQ'D?, COPAY, MAJ.
WHAT IS HCV?
HEP C VIRUS