Row 1
1) A concerned member who is locked out of their account is trying to reorder their prescriptions.
What is the correct guidance to offer in this situation?
a) Advise the caller you are going to unlock their account. Utilize CSR Password
Reset to unlock their account.
b) Advise the caller to login and click on “Forgot Password.” Utilize Mentor document:
Member Username and Password Issues.
c) Advise the caller you will need to escalate this incident to security. Utilize Mentor
document: Escalate an Incident to Security.
a) Advise the caller you are going to unlock their account. Utilize CSR Password
Reset to unlock their account.
A PDP member is traveling across the U.S. to visit family and friends. Can they get their
prescriptions filled in any state?
a) Yes, they can use any Humana pharmacy or get a vacation supply before they leave if they have not exhausted their limit.
b) Yes, but they’ll need to use CenterWell Pharmacy Mail Order for a 90-day supply of the prescription.
c) No, if traveling, they will be outside of their plan’s service area.
a) Yes, they can use any Humana pharmacy or get a vacation supply before they
leave if they have not exhausted their limit
When verifying prescription drug (Part D) benefits, where will you confirm if the member
reached or is nearing their initial stage?
a) Pharmacy Finder
b) CRM
c) RxNova Call Connect
c) RxNova Call Connect
When verifying prescription drug (part D) benefits in RxConnect, how will you know if a
medication requires prior authorization approval from HCPR?
a) “Prior Authorization”, “B vs D Determination”, or “Step Therapy” appears under
the Coverage column
b) “Quantity Limits” appears in the Coverage column
c) When the medication is Tier 4 or higher
a) “Prior Authorization”, “B vs D Determination”, or “Step Therapy” appears under
the Coverage column
Which RxNova Call Connect option provides the status of check issued to members
who submit a paper claim for Direct Member Reimbursement (DMR)?
a) Reimbursement
b) Formulary
c) Pharmacy
a) Reimbursement
Humana does not cover replacement of lost, stolen, or damaged medications.
However, you (the advocate) can offer members some helpful suggestions.
Which one of the following is NOT an appropriate suggestion in this case?
e) Advise the member to file an appeal with the insurance company for a one-time exception.
7) Members can choose to enroll in which Humana stand-alone prescription drug plans?
a) Value, Basic, or Premier
b) Preferred, Custom, or Elite
c) Enhanced, Standard, or Basic
a) Value, Basic, or Premier
When researching prescription drug (Part D) claims, where will you confirm if the
covered amount applied towards the member’s deductible?
a) RxNova Call Connect Reimbursements Paid panel
b) RxNova Call Connect Benefits & Eligibility Detail panel
c) RxNova Call Connect Claim Detail Benefits panel
c) RxNova Call Connect Claim Detail Benefits panel
A member expresses concern over the high copay cost of their prescription that their
PCP states is the only effective medication for them.
What is the best course of action?
a) Show empathy and advise them this estimate is accurate based on their current
plan.
b) Advise the member they can request a tier exception and warm transfer them to
HCPR.
c) Provide cost saving alternatives they can discuss with their doctor.
b) Advise the member they can request a tier exception and warm transfer them to HCPR.
How can you tell when a drug claim requiring correction was adjusted and reprocessed
in RxNova Desktop?
a) A date is visible in the Adjustment date field.
b) The claim source will always show “DMR Long”.
c) The Plan paid amount will show a dollar amount.
a) A date is visible in the Adjustment date field.
According to the Medicare Immunization Coverage Reference guideline, how is the
Pneumococcal vaccine covered?
a) Under Medicare Part B
b) Under Medicare Part D
c) HCPR must review to determine B vs. D coverage
a) Under Medicare Part B
Where in RxNova Call Connect is a member’s Low Income Subsidy (LIS) status located?
a) Benefits & Eligibility Deductible & Accumulators panel
b) Benefits & Eligibility Part D panel
c) Benefits & Eligibility Dual Coverage panel
b) Benefits & Eligibility Part D panel
The Member ID link from this RxNova Call Connect button is launched if needing to
review a member’s pharmacy accumulations from the previous plan year.
a) Claim
b) Reimbursement
c) Benefits/Eligibility
c) Benefits/Eligibility
When researching a denied drug claim in RxNova Call Connect, you find error code
“082” listed under the Errors & Messages panel, what does this mean?
c) Pre-authorization is required through HCPR.
The status of a prior authorization for a prescription drug can be found where in CRM?
a) Auth/Referral Summary tab under Pharmacy Authorization tab
b) Contact Handling Alerts section
c) Policy Member page under the Details tab
a) Auth/Referral Summary tab under Pharmacy Authorization tab
What is the only exception that would result in Humana covering a lost or damaged medication?
a) An isolated personal crisis exception.
b) A disaster exception.
c) An exception granted by the pharmacy due to prior authorization delay.
d) A one-time override request submitted by the member’s doctor.
b) A disaster exception.
Where in CRM is a member’s Low Income Subsidy (LIS) status located?
a) Person Account page – Communication panel
b) Person Account page – Policies section
c) Plan Member page - Eligibility Information section
d) Plan Member page – Authorization/Referral Summary link
c) Plan Member page - Eligibility Information section
When verifying prescription drug (part D) benefits in RxConnect, how can you tell if a
medication is not covered?
a) There are no Drug alternatives available.
b) “Not Covered” appears in the Coverage column.
c) The best deal indicator is not visible.
b) “Not Covered” appears in the Coverage column.
If, while researching a different denied drug claim, you notice error code “221” is listed
in the Errors & Messages panel, what does this mean?
a) The medication is for a drug covered under Part B only.
b) This is a duplicate charge for a claim previously processed.
c) The medication is covered, this is an informational error only.
a) The medication is for a drug covered under Part B only
If the indicator under the RxNova Call Connect Dual Coverage panel shows “S”, what
does this mean?
a) The member does not have other insurance coverage besides Humana.
b) The member has other insurance (OI) – Humana is secondary.
c) The member has other insurance (OI) – Humana is primary.
b) The member has other insurance (OI) – Humana is secondary.
When addressing access to care issues (where members are unable to obtain their prescriptions when they need them), you must always confirm the member has enough
medication to last how long?
d) 48 hours
According to the Extra Help/LIS Comparison guideline, if a member’s LIS status shows
1001, what subsidy level is this?
a) Subsidy 1
b) Subsidy 3 and 4
c) Subsidy 7
d) The member does not have LIS
b) Subsidy 3 and 4
When viewing drug pricing results in RxConnect, what indicator represents the best
deal for our members?
a) Lowest cost in the Member pays column
b) Lowest cost in the Total cost column
c) Amount corresponding to the green dollar sign
c) Amount corresponding to the green dollar sign
When confirming the amount (if any) a member owes on a drug claim, which dollar
amount in RxNova Call Connect represents the member’s responsibility?
a) Plan Paid amount
b) Patient Paid amount
c) Sub Ingr Cost amount
b) Patient Paid amount
Mail Order demographic Information edited under the Demographics section is limited
to ____________.
a) Primary phone numbers and email addresses
b) Alternate and Mobile phone numbers only
c) Contact numbers and email addresses
d) Email addresses only
c) Contact numbers and email addresses