Tools Part 1
What is the meaning of PANDA?
Prior Authorization Networking Decisioning Application (PANDA)
What is the KB number or KB article where we can find the descriptions of the main menu and main screens of the PANDA tool?
KB0099830/PANDA for Techs
What denial reason/s are considered not true denials in Medicare plans?
Plan Exclusion Inquiry
What details can we search for in PAS to assist us during the intake process?
1. Member Search
2. Provider Search
3. Drug Search
Using the PA case reference number PA-H6870126, what is the case status of the authorization?
Case Status:Resolved-Denied
What is the name of the feature in our tool that allows us to view the footprint of the last activity performed on a case?
World Clock in PAS
What is the KB number or KB article where we can find the CoverMyMeds (CMM) fax numbers?
KB0025539/Provider Information
In Medicare plans, which business segment/s are we not allowed to handle and are usually routed away because we are restricted from accessing those accounts?
EGWP/External Part D
Where can we identify whether a case is a barcoded fax?
PAS Tool
Using the PA case reference number PA-H6738288, what is the dispense quantity (DQ) and days supplies (DS) of the requested medication?
Dispense Quantity: 15
Days Supplies: 15
What is the name of the feature in our tool that allows us to edit active prior authorizations?
Edit Active Authorization
What is the KB number or KB article where we can find the carrier IDs of Non-Participating Plans (NPP) and Discount Card (DC) that we don't assist?
KB0027429/Non-Participating Plans, Non-Delegated Carriers, and Discount Card Carriers
How far back can we backdate a prior authorization for a commercial plan?
30 days
Where do we cancel a case?
Take Action
Using the PA case reference number PA-H5626777, what is the interaction type?
Fax
What do we call the process in PANDA where we take over an authorization without clicking the 'Get Next Case' option?
Take control of this case
This the KB number or article that we follow when changing the priority in PANDA from Urgency to Standard?
KB0068329/Correcting Case Errors and Manual Tracking
What types of review do we have in Prior Authorization?
1. Prior Authorization Required
2. Quantity Limit
3. Step Therapy
4. Non-Formulary
5. Plan Exclusion
Where do we document outbound calls made to providers or members?
Call Details
What types of attachments can we view in PANDA?
1. Corr Type: Inbound
2. Corr Type: ePA
3. Corr Type: Correspondence
Which screen is used to perform trial claims, duplicate checks, and case merging?
Action Screen
What is the KB number where we can find the description of each cancellation reasons?
KB0114629
When do we not consider the keywords 'Important,' 'Timely,' and 'Earliest Convenience' as indicators that a request is urgent?
If there are pre-printed options that aren't circled/checked/etc.
This feature provides guided handling processes when a duplicate case is identified at the Action screen (Initial Case Duplicates) or the Guidelines screen (Case Duplicates).
GuideMe
Using the PA case reference number PA-H6564048, is this a mergeable case? If yes, why? If no, why not?
No, it is not a plan that we handle.