DEMOGRAPHICS
what systems can you use to update demographics
CI, CRM
What are the possible claim processing outcomes?
Paid, Pended, Partially Denied, or Denied
WHAT 3 WAYS CAN YOU ACCESS CI?
DIGBOT,CRM,GO/HOD
what pharmacy dose Humana use for mail order prescriptions?
Centerwell Pharmacy
WHAT IS THE MAIN WEBSIGHT TO DIRECT PROSPECTIVE MEDICAID MEMBERS TO FOR INFORMATION?
Virginia Medicaid Website: www.dmas.virginia.gov
WHAT SECONDARY SYSTEM DO WE USE TO VERIFY MEDICARE
WIPRO
How do you access the Claim Summary page?
The hyperlink in Quick Links of the Plan Member page
WHAT SCREEN IN CI DO WE HAVE TO START WITH IN ORDER TO GET TO THE FOLLOWING SCREENS
PEDM, PAMG, PAIG, PAID
PAPI SCREEN
Humana replaces lost, stole, or damaged medications
NO WITH THE EXCPTION OF A NATURAL DISASTER
What PLAN is the acronym "FAMIS" referring to?
Family Access to Medical Insurance Security Plan. This is Virginia's health insurance program for children.
IF A MEMBER MOVED TO ANOTHER STATE DO THEY NEED TO CONTACT VIRGINIA Y/N
YES
What mentor would you use to log a claim?
CRM Service Logging
WHAT SCREEN DO YOU LOOK TO ORDER AN ID CARD
PAID
Where would you find a pharmacy location for a member and email it to them?
Find a pharmacy -> Pharmacy Search -> Send contact information option
WHAT IS THE DIFFERENCE BETWEEN ALIGNED AND UNALIGNED
WHAT DEMOGRAPHICS CAN WE NOT CHANGE
DOB,DOD,NAME,SOCIAL,&GENDER
What systems do we use to view claims for Medical and Pharmacy
CRM & CAS/CI
WHAT SCREEN IN CI CAN YOU VIEW THE MEMBER ADDRESS
PEDM
What mentor do we follow to resolve error code 090? And what is the meaning of the error code.
Mentor: Actions for RxNova Error Codes
Code: Submit Claim to Primary payer
When the member is expressing emotional distress, suicidal threats or ideations, and they agree to speak with a behavioral health professional, you will begin a 3-way conference call with 9-1-1 emergency services for the caller's state/region to put them in touch with the correct professional service provider.
NO
CAN A MEMBER HAVE A PO BOX AS A RESIDENTIAL ADDRESS.
YES IF THEY ARE HOMELESS
How do you log into/ access CAS
CI
WHAT SCREEN CAN YOU USE TO LOOK UP A MEMBER WITH THE FIRST AND LAST NAME AND DOB?
PESL
How many drug classifications are there and what are they called
7
Over the Counter (OTC), brand, generic, maintenance, compound, controlled, and specialty.
Cost-share protection for Dual Eligible members is the out-of?pocket amount that members will NOT need to pay. This can include deductibles, coinsurance, and copays and premium payments.
FALSE