Dashboard Basics
This section on the dashboard shows patient information and you are allowed to create a ticket from here
What is the patient blade
3 out of 5
What is a formulary?
A list of covered medications
PA stands for this
Prior Authorization
What template is used to initiate a PA ?
CC_Clinical PA Request
This section on tredium shows the patients accumulators
Benefit Balances
HIPAA stands for this
Health Insurance Portability and Accountability Act?
A formulary can be either open or?
Tiered
This party usually initiates the PA request
prescriber
What rejection is shown in tredium for reject code 52?
Non-Matched Card Holder ID
This section in tredium shows the patient's contact information
Communication Tab
True or False: If a patient's spouse would like to speak on behalf of the patient but does not have a PHI form on file we would not need to ask for permission from the patient.
False.
Where can we check if weight loss drugs are included or excluded?
Pharma Facts
What 2 things do we look for when adding a drug under associations?
If the drug is active or repackaged
What rejection code is for alternative drug?
608 Step Therapy
What section on tredium would you go to search for a ticket?
Customer Service then ticket search
What are covered entities and business associates?
Pharmacies and Providers
Tier 1 drugs usually have this characteristic
Lower drug cost and copay
This reject code signals a prior authorization is required
75
When do we use the template CC_JMTTICKERUPDATE
if anything is needed to be changed on JMT for example: MDO Number, fax, change pa to urgent, have an appeal form to be sent
Where would you go to search the plan coverage dates?
Patient Tab
What is Protected Health Information?
Name, Date of birth, address, SSN
Tier 3 drugs usually have this compared to Tier 1?
higher copay or coinsurance
Once the PA has reached a determination what is the next step?
Patient is able to fill prescription at pharmacy
True or False: We are able to initiate a pa for reject code 70
False, only if the patient has taken the medication before