RX BASICS
RX VOB
RX CLAIMS
RX COB
RX PA
100
If a member is not active in RxNova, what do advocates ask members experiencing an Access to Care issue?
Do you have enough medication to last 48 hours?
100
what is the class/intent for Diabetes related call types
- Classification: Rx
- Intent: Insulin Coverage
100
what are the 3 Rx claims types?
Point of Sale (POS or Retail)
DMR Paper
Mail Order
100
What is COB?
Coordination of Benefits (COB)
100
what is the class/intent for Rx PA
- Classification: Rx
- Intent: Prior Authorization
200
Medicine can be introduced to the body in several methods..What are those methods?
- Orally via pill, tablet, capsule, or inhalant
- Nasal spray or mist
- Patch, lotion, or cream applied to skin
- Liquid eye drops
- Suppositories
- Injected via syringe and needle from a cartridge or ampul; a sealed glass capsule containing a liquid
200
what are the Preferred brands for Diabetic supplies
True Metrix Blood Glucose meter, True Metrix Air Blood Glucose Meter, True Metrix Blood Glucose Text Strips
200
Name two Pharmacy Identifiers
BIN and PCN Numbers
200
Customer Service is responsible for confirming the information Humana has on file is correct and to
Address general COB questions.
Report corrections to the appropriate department.
Resolve COB-related claim denials.
200
What are the types of PA?
Preauthorization
Clinical Authorization
300
How are medications classified?
Over the Counter (OTC), brand, generic, maintenance, compound, controlled, and specialty
300
What are the name of Adult Vaccines recommended by the CDC
Influenza (flu), Pneumococcal (pneumonia), Shingles, and Tetanus. Other common vaccination types include:
- Tetanus, diphtheria, and pertussis (TDAP)
- Measles, mumps, and rubella (MMR)
- Varicella (Chicken pox)
- Human Papillomavirus: Gardasil Human Papillomavirus (HPV) Vaccine
- Hepatitis
- Meningitis
- Coronavirus
300
What information can be found in the Errors and Messages panel in Rx Nova
Last fill and next fill date available
300
what is the name of the screen in CI to verify Other Insurance?
CRI Screen
300
PromptPA cannot be used to initiate a prior authorization review for what type of drug?
Compound
400
what are the name of the categories in RX NOVA?
Benefits/Eligibility
CLAIMS
PHARMACY
FORMULARY
REIMBURSEMENT
AUTHORIZATION
400
Whate are the places of treatment for mbers to be vaccinated
Retail pharmacy
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Doctor's office
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Retail clinic inside a Pharmacy or Grocery store
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Emergency Room
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Urgent Care
400
what is a test claim
Claim tests enable Customer Service advocates to simulate how prescription drug claims will pay at the pharmacy without generating an actual payment in RxNova.
400
Customer Service NEVER changes a member’s OI status in what two systems?
RxNova or Customer Interface.
400
What information is always provided to the member after initiating a prior authorization review in PromptPA?
Episode of Care (EOC) ID
500
Which option below correctly represents this member's benefit and eligibility status
This member receives Low Income Subsidy assistance and also participates in the Medication Therapy Management program
500
Which characteristics describe specialty drugs?
Treat chronic and complex medical conditions
Typically have special shipping or storage requirements
Most require prior authorization approval by HCPR
500
what mentor document do we use to better understand denied claims in RxNova?
Actions for RxNova Error Codes
500
what mentore document is used for a test claim
Pharmacy Claim Tests Using RxNova Call Connect
500
What are the codes are used that requires clinical information from Prescribing physicians in RxNova?
- 014: Prepay review needed (non-formulary drug needs an authorization)
- 151: Prescribed dosage exceeds quantity limits, or is outside the plan maximum for day supply and/or quantity allowed
- 080: Member is attempting to refill their prescription before 75% of the medication has been used
- 082: Preauthorization is required