Claims
The real time system where you view claims?
COS (Client Service Portal)
What is the name of the system that house Part D authorizations?
Compass
What is the name of the article that gives all the links for Pharmacy Helpdesk?
PDP Links, Pharmacy helpdesk Links, CCP Links
What is the meaning of a 88 or 79 Reject code?
Refill too soon.
Where do I find Part B authorizations?
PEGA
What link do you click to view overrides or place an override?
Manage Overrides
What two tabs do we use in Compass?
Care & Communication
I am looking for the description of a rejection. What article can help me?
Pharmacy Reject Trouble shooting
What does LIS stand for?
Low income subsidy
The system that holds all the notes to calls made for the specific member?
Careconnects
The member is asking about their deductible and want to know if it has been met. What link do I need to click on?
Accumulations
What tab do I go to view DMR requests?
Care tab
Can central point be accessed from careconnects?
YES.
What system provides copayment information for Medicare Part D?
Sensentia
Where do I go to look up a provider or pharmacy NPI?
NPI Registry
Where do you go to view the pharmacy and provider lock in list?
Provider Overrides
What tab do I look under to see faxed authorizations in Compass?
Communications Tab
What is the timeframe for the member to receive a Direct Member Reimbursement (DMR) check after it has been approved?
The member will receive a Direct Member Reimbursement (DMR) form in the mail within 10 through 14 business days.
What system do you go to view your daily breaks and lunch?
NICE.
What link do you click on to view LIS information?
Manage Medicare
Under the communications tab where do I go to see what we have sent to the provider or the member?
Correspondence
True or False
Centralpoint is where I find department updates?
TRUE.
The member is needing a vacation supply that is over 90 days and 30 days for specialty medications. What do the caller need to do?
Medication requests greater than a 90 or 30 day supply for specialty will require Proof of travel to be submitted to 813-283-3346
Citrix