Quality
We Complete FULL Quality Check for all Document Review WHAT cases?
What is Enrollment
This is the days supply ALWAYS
What is 30 days
Medicare Part B will always be entered as a
What is Medical Benefit Profile
We fill out this blurb when calling out to Medicare plans?
What is Medical payer call- Medicare/commercial
Patient is 64. We screen for what?
What is Medicaid
The 2 places to add Alternate contacts
What is the Person account page under alternate contact and Person Account in the “Contact Details”
This is where we determine how many bottles we are shipping out
What is dispense dosage
Method of Completion on BV case if we call out to payer
What is Phone Call to Payer
Calling out to Payer for commercial benefits and we are 3rd partied
What is Undisclosed blurb
Patient is getting 750MG Orencia and has a Medicare AB plan. What is the OOP/3% amount we add to the pt stated?
What is $661.64
If a commercial patient adds an alt contact name but nothing else, this is
What is MI
Sending out a loading dose of Orencia and a Maintenance dose means we will have 2 what
2 dosage details
The subtype for medical in the benefit profile is
What is AOB
Patient is approved for Opdivo. We use what blurb?
What is Part B approval blurb
We always add this note prior to working?
What is working note
We must enter this under site relationship for the program brand we are working
What is primary site contact
Patient gets 480MG of OPDIVO q 4 weeks. We send out how many of what vials
What is 2-240MG
Medication is covered but requires a PA the outcome is
What is Covered/Exception Required
Patient has now met the 3% for Abraxane after being denied for not meeting 3%. We use which blurb
What is 2nd determination blurb Part B 3% OOP met
OBC to payer we say we are calling from?
What is "On behalf of the doctors office"
These part B medications we do not need DX code
What is Orencia IV
Patient gets 180MG Abraxane D 1,8,15 q 3 wks. We send what out?
What is 12-100MG vials
Medication is not covered according to the NCCN. The outcome will be?
What is Not covered/Does not meet medical criteria
Patient is getting assistance for Opdualag which LIS blurb do we use?
What is we don't screen for LIS as they are not applying for a part D med
We do FU3 for all part B meds except
What is Reblozyl