Definitions
PAS
Customer Advocacy
RxClaims / Indexing
Misc.
100
A request for payment of benefits.
What is a claim?
100
When working a fax, when would the RXPA flag be selected from the RxFlag drop-down list?
What is never?
100
Name the 7 pillars.
What are 1. Problem Solving; 2. Adaptability; 3. Education; 4. Performance; 5. Understanding; 6. Compassion; and 7. Relationships?
100
The first three things you should do when indexing (once you have already hit "Run All") are...
What are 1. check all pages for urgency; 2. search for the member in RxClaims by name and DOB; and 3. look at the carrier code of the plan?
100
Name the 2 "what if" screens that you could see in PAS.
What are 1. active authorization screen; and 2. case duplicates screen?
200
A formal process requiring a doctor to obtain insurance approval for a particular service or procedure before it is received.
What is prior authorization?
200
This is the instance you would change an edit.
What is age limit?
200
The amount of time it takes to set the tone of the call; and the amount of time it takes to deliver a sincere and clear greeting. (2 answers)
What is 30 seconds; and what is 6 seconds?
200
A carrier code that is 4 numbers long would tell you that you need to enter ______ into the Case ID in IndexPlus.
What is INV-?
200
Medicare plans (PDP and MPD in the carrier) have a __ day waiting period from a denial resolved date before new PA requests can be reviewed.
What is 60?
300
The process of determining the amount of a claim that will be paid.
What is adjudication?
300
The 3 instances that you would need to merge a case.
What are 1. pending incomplete; 2. pending provider response; and 3. pending RPH review (new/different information).
300
Treating the caller's problem statements as if they are personal attacks on you refers to...
What is personalization?
300
When viewing a member's claims, this F key will show you the trial claims that have been submitted.
What is F22?
300
A new fax PA request is being submitted within 24 hours of an approval for the same medication and PA type... what reason do you use to cancel the case?
What is duplicate request fax?
400
A limitation or condition.
What is an edit?
400
This would prompt the Manual Eligibility Check Screen to pop up.
What is PAS is unable to locate the plan's benefit information for the member?
400
Name the 2 varieties of impairments.
What are 1. physical; and 2. cognitive?
400
If you need to run a trial claim for a specific NDC, how could you change the NDC in the trial claim screen? (name 1 of the 2 different ways)
What is 1. copy the NDC from PAS and paste it into RxClaim OR 2. hot key the NDC field in the trial claim and search for the drug?
400
A carrier code of PRX would tell you that the member is...
What is a PartnersRx member?
500
The system used by prior authorization technicians to process a request.
What is PAS (Prior Authorization System)?
500
These 5 fields could be auto populated in PAS if the provider enters all of the correct information into the IVR system.
What are 1. member ID; 2. member DOB; 3. provider ID (NPI); 4. GPI (drug); and 5. ICD-9?
500
Name the 2 influences that make up a phone interaction.
What are 1. tone; and 2. what you say?
500
If you hot key the _____ _____ in the member details screen, you can see the copays for the member.
What is the plan code?
500
A carrier code of UHCCS or ACU would tell you that the member is....
What is an Americhoice member?
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