HIPAA
MedHok
Test Claims
Anything
PeopleSafe
100
Needed for authentication on every call.
What is 1 Primary and 2 Secondary's Elements ?
100
This is needed when sending out a fax for the person who called in for it.
Place the ATTN:(Name) in the who field on the fax.
100
Use this screen to find out info on the drug.
Drug Information screen
100
According to CCF Step 5 (Closing Your Member Experience), you should ask a ____________ question.
Resolution
100
David Jones has called about his prescription benefits. When you look up his member eligibility status in PeopleSafe, a NOT ELIGIBLE indicator is displayed. How should you communicate this to Mr. Jones?
Mr.Jones I need to Transfer you to customer care for further resolve.
200
123-45-6789A
What is the HICN (Medicare Number)?
200
This is to be used as a last resort for a fax form
SSI Model Form in Medhok.
200
Use this number to already pull up the drug that was already ran by the pharmacy in the test claim.
Dispensed ID
200
Examples of PHI include: (Select the five that apply)
Plan Member Names Plan Member Birth date Plan Member Telephone #s Plan Member ID# Plan Member Address
200
What we do when a Fallon Member calls in or After Hours (Need Details)
Place a RM task. Able to describe the process.
300
You use this as a last resort for locating a member in the system
What is name and DOB Search?
300
This is where you will find the PA's that have already been sent in and or worked.
Under the Case tab
300
Quantity Limit __ PA Needed __ Step Therapy __ Tier Exception __ Non Formulary __
76 75 75,76 N/A 70
300
Use this tab in PeopleSafe to see PA info for ones that have been sent in.
Plan Benefit Override (PBO)
300
Indicate where you would click to access information for how a plan handles Prior Authorizations, Plan Benefit Overrides, and Appeals.
CIF hyperlink to CareSource
400
What we do when a 3rd party calls in
Is the member aware that you are calling on their behalf?
400
We use this tab when we need to send out previous letters out to MDO and or members that may need another copy.
Correspondences Tab
400
Rejected claims and rejected test claims may show both a Settlement Code indicating that plan limitations have been exceeded and an informative Settlement Code indicating what the plan limitation is. (True or False?)
True
400
The 3rd Party that handles 2nd level Appeals
Maximus
400
DOUBLE POINTS!! This is the Log Activity code needed to be used every call.
1011 PA
500
We cannot provide this info to the Retail Pharmacist
Effective and Term dates for a PA.
500
DOUBLE POINTS! We do this when we cannot find the correct form to send out. ( I need steps in correct order)
1. Get the NDC number of the drug needed 2. Right click on the Case Tab and click ADD. 3. Paste the NDC in the Fields and take out the dashes. 4. Click on the ? next to pending 5. Take the name off of the top of the tab and send out the form.
500
Place the following steps in the correct order for correctly calculating the quantity of non-tablet/capsule medications. (Number each step
1_ Find out how many total uses are needed per day. 2_ Calculate how many total uses are needed for the day supply. _3_ Divide total uses needed for day supply by the “Usage Qty Pkg”. If the result is not a whole number, round up. _4_ Multiply the total number of packages needed by the package size
500
Using the related work instruction as your guide, place the following steps in the correct order (1-5) to edit a task you've created.
_1_ Select the Resolution Manager tab _2_ Select the Cancel/Edit task tab _3_ Select the hyperlink of the RM Task to be edited in Task Details _4_ Make edits to the task _5_ Select Save
500
After performing a Test Claim, where would you click to see the Test Claim Results screen, which displays the Settlement Codes to assist you in the Test Claim interpretation?
Details link
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