DPAS
When getting CSR calls where do you look for transferred topics?
work list history
True/False Quantity Limits must have PSS?
True
____ before PHI?
NPI
What is the preferred way to look up a drug in MF?
GPI
How to get to claim detail screen?
Double click claim ID number
Wrong redial button can result in a wrong what?
MONY Code
When doing linking topics what template must be used?
informational template
What question must be asked before closing a call?
"Do you have anymore questions? Is there Anything else I can help you with?"
What color does the screen turn for jv members ?
PINK
How long is a topic tolled ?
24 HRS
Where do you find extensions ?
Prior Auth tab
A member calls and says her provider wrote her a prescription for Vicodin the directions are: 2 tablets ever 4 hours as needed for pain for 10 days. The plan pays for 180/30 which edit is needed ?
Quantity limit
True/false? If appeal is filed a new edit can NOT be done on the 61st day
True
What template is used for B v. D?
PA Template
Which state has a home infusion drug list?
Florida
Next Step and PA decision for withdrawn request?
Next step is awaiting response; PA decision is other
When is the Qty-No Upper Limit override used ?
OJ quanity limit
Which is worth 10 point that can either be added or deducted from your QA score: Asked Fact-Finding Questions or Providing accurate Information?
Providing accurate Information
What are the 4 hospice drug categories ?
Analgesic,Anti-vomiting /anti-emetic, Laxatives, Anti-anxiety
ADVAIR is a brand name drug what is the mony code ?
INCLUDE INCLUDE INCLUDE EXCULDE (IIIE)
Which is the correct way to put quantity in dosage field : '10 tablets per 20 days' '1 tab bid for 20 days' '10/20'?
'10 tablets per 20 days'
[amount and form per number of days]
A provider calls in and is requesting a coverage determination of behalf of one of his patients for Prolia. The provider confirms this IS in fact a buy and bill. What template should be used for this edit? Should the call be transferred?
informational ,Yes transfer to part B
What queue would you send a Louisiana member denial to?
1010 Medical directors group
A member calls for a step therapy for Abilify after putting the drug in master formulary you get a yellow pop up saying a step therapy is not required for this member on their plan? What template should be used ?
Informational
When are GFE (good faith calls) calls made?
When an edit is in danger of falling out of compliance