ADMINSTRATIVE REJECTS
Test claim for a 90 day supply is rejecting 7X for Maximum Days Supply, how do we troubleshoot this reject?
What is UPDATE CLAIM FOR A 30 DAY SUPPLY
This Italian dish is made with layers of pasta, cheese, and sauce.
What is LASAGNA
Provider sent in an appeal for a FL BLUE NATIONAL ALLANCE FI member for a denied QL review. Are we delegated for the the appeal?
What is YES
This Supervisor's fun fact is "I love to try and solve criminal cases . I am obsessed over any type of crime involving mystery."
Who is Kita R
Dual review for CBC, PA Portion was approved CE portion was Denied and there is NOT an Auth Needed indicator- should a courtesy PA be entered?
What is NO
Test claim is rejecting 70 with message Non-Participating Pharmacy, how do we troubleshoot this reject?
What is RUN CLAIM USING A DIFFERENT PHARMACY ID
This tropical fruit has a spiky outside and is often used in pizza debates.
What is PINEAPPLE
For NJ, the INITIAL case was Denied for PA. The provider sent in AI after the case was denied. What would the Classification be for this review?
What is FIRST LEVEL APPEAL
This Supervisor's fun fact is "I have over 30 nieces, nephews and grandnieces/grandnephews"
Who is Manny A
How far back should you backdate your authorizations for (excluding the clients that don't backdate)?
What is 30 DAYS
Test claim is rejecting 76 with message SPLIT FILL DURATION X1-3 MONTHS, how do we troubleshoot this reject?
What is CHANGE THE QUANTITY AND DAY SUPPLY FOR A 14 DAY SUPPLY
This Japenese food consists of vinegared rice often paired with fish or vegetables.
What is SUSHI
There is an INITIAL and RC review on file for BCBSTX account, next level would be a FIRST LEVEL APPEAL. What note would you leave in the case?
What is "Non-delegated appeal."
This Supervisor's fun fact is "I competed in local rodeos running barrels."
Who is Barbara H
Dual Review- PA portion was approved QL portion was denied, what should we do?
What is ENTER A PARTIAL APPROVAL (PA AUTH FOR WITHIN QL)
Test claim rejects 70 with message NDC NOT APPROVED BY FDA, how do we troubleshoot this reject?
What is UPDATE NDC TO SEE IF ANOTHER NDC PAYS
First introduced in 1987 and named for a legendary gutarist, this iconic flavor of ice cream is the most famous of the brand's fan-suggested concoctions.
What is CHERRY GARCIA
Zepbound was denied as a BE for a NJ member. Provider sent in an Appeal request- what would the classification and the program type be?
What is INITIAL and NON-CLINICAL REVIEW
This Supervisor's fun fact is "I have had the privilege to travel to 15 different countries in my lifetime."
Who is Danny U
What should you do after entering a PA?
What is RUN A TEST CLAIM
Test claim rejects 70 or MR with message MEMBER MUST CALL PAYER MATRIX TO TO ENROLL 877-305-6202, how do we troubleshoot this reject?
What is CLOSE CASE AS NCR. This request is non-reviewable.
Invented by an Ohio franchise owner and added to the national menu in 1968, this iconic sandwich features two all-beef patties, special sauce, lettuce, cheese, pickles and onions on a sesame seed bun.
What is the BIG MAC
For NJ ASO OPT-IN 2nd level appeal, what form NEEDS to completed and signed?
What is the ASO OPT -IN FORM
This Supervisor's fun fact is "I danced my entire life. I danced for Dancing Dolls and was on the Bring IT show I have done: Ballet Jazz Tap Contemporary and more"
Who is Katlyn S
Dupixent was approved for over the QL for up to 4 pens per 28 days (the UofM was in pens), how would you detail the QL on the PA?
What is .286 ON THE DAILY SIDE