Basic Information
Which Tool is used to verify prescription drugs benefits for member?
RxConnect Pro
The Term HCPR means what?
Humana Clinical Pharmacy Review
True or False?
There are currently 4 benefit stages.
False
True or False?
The error code 090 is only overridden by HCPR.
False
COB errors aren't clinical and aren't transferred to HCPR.
The Medicare prescription payment plan is an optional payment program that can help participating members manage covered Part d prescription cost.
List 2 preferred pharmacy?
Walmart, Walgreens, CVS, Rite Aid, CenterWell, Kroger, Publix
According to the SPAP Job Aid in mentor, What is the name of the SPAP program offered in Maryland?
What is the telephone number for them as well?
Senior Prescription Drug Assistance Program
800-551-5995
What Tab in Rx Nova allows you to enter an override?
Add Auth
Using the actions for RxNova error Codes mentor, The denial code 016 indicates what?
Can This be overridden?
The National Drug Code (NDC) ins't listed in the RxNova drug database.
No- Don't override
The Claim Status REV indicates what?
The claim charges was reversed by the pharmacy.
What is the formulary?
A document containing a list of prescription drugs covered by a prescription drug plan, also known as a drug list
This Type of request asks Humana to cover a non-covered drug.
Drug List Exception
Using mentor, a member receiving extra help with a subsidy level 2 pay how much towards a brand drug?
$4.80
Define split claims.
This is where a claim is processed under more than one benefit stage. Where a dollar amount is applied to each stage.
Pharmacy Access to care issues are handled by what team?
DESU- Dedicated Eligibility Specialist Unit
True or False?
A Brand drug is stronger and more effective than a generic drug?
False. Both a Brand and Generic drug has to have the same quantity of active ingredients.
What should you always ask members experiencing an access to care issue?
If they have enough medication to last 48 hours
After an override is entered or performed, advocates are required to do what?
Verify Coverage to ensure the claim will be processed accordingly with any hard Erros.
The PEOC screen in CI allows us to see what information?
Other Insurance information
Capsules, Tablets, Liquids, Semi-solids, Aerosols, Injectables, Lozenges, Suppositories
True or False?
Lancets, Insulin, Gauze, alcohol and swab are covered under Medicare Part D.
False
Lancets is covered under part B.
There are 2 Numbers on the member's ID that is needed when processing a pharmacy claim, what are they?
BIN (Bank Identification Number)
PCN (Processor Control Number)
What is the duration and days supply when entering a Mail order delay one time override?
Duration:5 days
Days' supply: 30 days
When running a claim test in Rx Nova, what is the submission clarification code to determine if a member has exceeded their vacation override?
003
What section in RxNova Allows us to identify the GCN (Generic Control number) and Manufacturer?
Claim Detail - Drug Information