QTY/DS
Directions: 1 tablet BID
Requested quantity: 60
What is the QTY/DS?
60/30
(1 tablet BID (twice a day)
60 capsules รท 2 times per day = 30 days
60 capsules per 30 days)
Where do you send fax if the request is for DME?
CIT
How do you identify if the drug is a COMPOUND DRUG?
Compound indicator is 2 or 9
What is the only plan eligible for Tier Exception?
Medicare
If you encounter hospice process, admission with medication. If multiple medication, you need to create multiple EOC for multiple medication. YES or NO?
YES
Directions: 3 capsules every 6 hours for 7 days
What is the QTY/DS?
84/7
(3 capsules, 4 times a day = 12 cap per day
so 12 capsules x 7 days = 84 capsules for 7 days)
Where do you send fax if the request have PAP form?
PAP
Is Clinisol a TPN compound drug?
YES
If you have a tier 1 drug, what product will you use?
Tier 1 Exception Not Eligible
If the member is requesting to switch to other alternative medication, what will be the process?
CANCEL PA
What is the default QTY/DS for Zoledronic Acid (Reclast)?
100/365
Where do you send fax if the request is for Procedures/CPT Codes?
CIT
Do you SKIP test claims on TPN product medications?
NO
If you have a tier 4 drug on a tier 4 plan, what product will you use?
Tier Exception Not Eligible; Drug
"d/c this medication". What will be the process?
CANCEL PA
(d/c means discontinue)
What is the default QTY/DS for Prolia?
1/180
Where do you send fax if the member plan is CarePlus?
CarePlus
If your requested medication is Dextrose. What product will you use?
TPN Products
If your process is for Tier Exception and you have 211 (CMS) hard edit, what product will you use?
Tier Exception Not Eligible; CMS Excluded
"Patient not treated on this clinic." What will be the process?
Privacy Breach
Request for Eylea
ICD 10: H35.3111 is for early dry macular degeneration in the right eye
What is the QTY/DS
0.05/28
(The diagnosis indicates the request is only for right eye, so the qty is for one eye, 0.05mL)
Where do you send fax if the request is a stand-alone Rx/Prescriptions without Centerwell Verbiage?
MD Office
If the requested medication isn't a TPN compound drug. What product will you use?
Administrative-Compounds
If the request is for TE and you have hard edits 480 and 211. What product will you use?
Tier Exception Not Eligible; CMS Excluded
(CMS is prioritized over NF TE)
If there is DAW on fax, will you create an EOC for generic name if the requested brand name is obsolete?
NO (brand name only)