Medicare Migration-
SOP COM4993
SOP COM4993
Eligibility
Overrides
CGM-
SOP COM4338
SOP COM4338
Bonus X2
100
Is CSP currently filling Specialty Medications for Medicare customers?
No, CSP stopped shipping/stocking specialty medications 11/08.
100
Name the three systems we use to quote eligibility?
Facets, CED, Genasys
100
To override a 159 error the total claim cost must be under [BLANK] per 30 day supply.
$2000
100
True or False.
-CGM Sensors are covered under the patient’s pharmacy benefits.
True
100
Name Two of our One RX CBC's.
Ali Mahmoud
Amy Peeler
Jocelyn Jones
Madison Rowden
200
Will Medicare specialty medications be automatically transferred to Accredo?
No-
Medicare B, prescribers must submit submit a new, original prescription to the patient’s pharmacy of choice. Medicare D, The request for transfer of prescription MUST come from the patient only.
200
What screen in CED do we quote eligibility from?
GOIP Screen
200
What is the maximum amount of medication we can override for patients working abroad?
1 year supply.
200
True or False.
-CGM Transmitters and readers/receivers are covered under the patient’s pharmacy benefits.
False
200
What professional baseball team did Joe Markulike play for?
Atlanta Braves
300
When speaking with a Medicare patient, We must never sway, steer or [Blank] one pharmacy over another.
What is [Encourage]
300
What Product can we quote eligibility for in Facets?
518 Great West
300
What is the SOP that lists and clarifies RX Nova Denial Codes?
DOC ID-RES39439 Rejection Codes OneRx Pharmacy Call Guide
300
Is CVS a participant in the CGM E-Voucher program?
Yes
300
Where did the Mayflower Pilgrims land in 1620?
Plymouth Rock
400
If a Medicare customer has questions on in-network pharmacies, benefits, or price quotes offer to transfer them to the appropriate Medicare extension. You can reference [Blank]
PP936 Transfer Call.
400
What three things must be present to quote active coverage in Genasys?
ONLY look for a PBM line - if NO PBM line - NO RX coverage
Check Effective & Term dates - if all 00s this is good & indefinite like 12/31/9999
- Void - Y or N - if Y no Pharmacy coverage - if N not voiding so they DO have Pharmacy coverage
400
Errors-029, 151, or 82
What is the maximum number of test strips per day front line staff can override.
You can load an indefinite override for up to 15 test strips/lancets per day without taking a PA. If higher quantities than this or any additional rejections (e.g. 141) you need to take a PA.
400
Can express scripts fill CGM products?
No, If a client has migrated to the ESI systems, that customer needs to use a Retail Pharmacy.
400
What does NPS stand for?
Net Promoter Score.
500
What Accredo phone number is provided to patients receiving Medicare prescription transfer letters?
877.826.7657
500
When checking for active pharmacy coverage in CED, What must be listed on the GOT-7 screen?
Under Ben Type, it must list "RX".
500
What do we need to check before placing any override on a 519 account, and where is it located?
519 Benefit Documents-Located in advocate resources of the Daily Dose.
500
Can patients continue to fill CGM products through CHD?
Yes-Active Argus/DST users can continue to fill CGM devices through CHD until their account shows migrated in OneView.
500
What breed is Gene's dog?
Scottish Terrier