Quantity limits might not be so much fun for the patient and his drug, but it's pretty durn easy for us to spot the QL reject. Why? The reject's got this number, that's why.
What is 76?
100
George Clooney was a stud doctor on the TV show (EXTENDED RELEASE).
What is er?
100
We all received a welcome email to the PA department a week or so ago. It was sent by this person. Who is she? Oh, just the Senior Director of the Prior Authorizations, that's all.
Who is Sunshine Lujan?
100
This is implemented when the PA happens to have no protocol found for the med or any request type entered. Poor thing.
What is Lite Criteria?
100
Maybe you've got an A5 screen that looks dehydrated, so why not refresh the screen, and use this key to do it?
What is F5?
200
♫ Money, money, money, money ♫ ... think of that song when you enter a high dollar override. Then you'd always enter the dollar amount for this much over the amount the drug is rejecting.
What is one hundred dollars?
200
Welcome to McDonald's. How about a cholesterol-packed, piece-of-grease Big Mac? It's got two all-beef patties, special sauce, cheese, onions, lettuce and a couple of (DILUTE) pickles, plus one "L", of course.
What is dil?
200
Last week, we got word that this override is going to need an "OD" for the entered in as the Reason Code. This was after "further research," of course.
What is Quantity Limits?
200
Shame on YOU. There was a PA request assigned to you and you took off for the day without so much as reassigning it back to the same queue from which you pulled it. Obviously, you failed to check this before you left.
What is the "User Request" queue?
200
In Rx Auth, you'd be using the Let Us Rock And Roll On A Segway method to update and verify all the fields of a PA, then you'd this function key to submit it and rock on.
What is F6?
300
A lot of tall buildings have no floor with this number. Then there's the calendar, Friday the something is unlucky. In Rx Auth, you'd be hella unlucky if you don't enter the number in as a request type for a step therapy PA.
What is 13?
300
Dang, that miserable son-of-a-beach. He makes me so mad, I'm gonna call him (SHORTNESS OF BREATH) for short from now on.
What is sob?
300
We received a new PA form for this plan last week. And yes, we will be faxing that form, but we will NOT handle the PAs for it.
What is Health Alliance (HAMP)?
300
The first screen to come up in the Content Management Portal will be this screen, at least for most of us. If not, you'll need to bring it up for sure, as it's more needed that the "FAX SEND ERRORS" screen.
What is the Document Search?
300
Need to cancel a PA? Well then, you'd mosey on over to the "Request Detail Screen" in Rx Auth, then select this fun function key.
What is F15?
400
Q&A will be giving you this many points for the "RESPONDS APPROPRIATELY" section. After all, those "sirs" and "maams" are important, to say nothing of bridging and apologizing.
What is 15 points?
400
You're on a ship, lost at sea with no hope of survival. Well, I'm sure glad I'm not you! But you'd better get on your morse code device and send an (IF NECESSARY) pretty durn quick.
What is sos?
400
DAILY DOUBLE
It was on October 16th that Sonya Pierce generously shared an email. It read: "Please be advised that QualChoice of Arkansas does not cover" this name brand drug. "It is an outright exclusion." Any questions?
400
What? Your test claim is showing the wrong co-pay after you entered the override? Well, you might have to change to "P" to a "Y" or "N" and then edit the sucker. And you're doing this if you're fixing the override to make the drug pay correctly.
What is Best Practice?
400
Whoops! In Rx Auth, you just found a frikkin' faulty fax number for Dr. Frankenstein of Fluffyfluff, Florida ... fudge! So, you'll use this F key to fix the fax number for full informantional fidelity.
What is F11?
500
While in A5, you're gonna need to F8 to the member detail list screen, where you'll find the "CLINICAL" function, a totally indispensable tool for PA processing. To access "CLINICAL," you need to enter this number. It was Michael Jordan's number on the back of his jersey.
What is 23?
500
Suppose a certain supervisor in this room had the middle name of Thomas, Tiberius, or Thelonious. Spell out those three initials and it reads (GIVE AS SUCH DOSES).
What is dtd?
500
DAILY DOUBLE
According a CALL CENTER DOCUMENTATION email we got yesterday, anytime a member calls with a question for a pharmacist, we can give them a nice, warm transfer to x1023660, which is this line.
500
Don't use the Call Tracking Template here! But you will be clicking on this particular link to find OTHER useful links when reviewing a PA request. It's located on the Prior Authorization Operations Screen, of course.
What is the Knowledge Base?
500
When generating a notificaton, you might need to update the contact information. In that case, you'd click on this function key, which is designated as "CONTACT OVERRIDE."