Category 1
You must verify two pieces of this information pertaining to the claimant at the beginning of the call before providing any HIPPA protcted information to the caller
What is PHI
IN DOL universe home screen, What key function will take you to the screen where the HIPPA note is housed
What is F6
When closing a call what question should be asked before disconnecting the call?
What is "Is there anything else i can help you with"
To what deparmtment would you transfer a prescriber having trouble registering for the prescriber portal in attempts to submit a PARF
The Bin and PCN used to process the medications at the pharmacy level are ?
Bin: 004261 PCN: DOL
PARF stands for what?
What is Prior Authorization Request Form
An initial opioid can be filled for this number of days?
The first opioid being filled on the claim or after 180 days where no opioids have processed on the claim
What is 7
When referring to the DOL claims handler, what is the appropriate title to refer to them as?
What is claims examiner
When a medication needs to be webbed out for review what step should the associate take to have the medication webbed out?
What is send an email to leadership / Fed Assist for leadership to web out med
When making an outbound call what statement is required to be said at the beginning of the call to ensure quality
What is: This call may be recored for quality assurance purposes
When recieving an inboud call, what specific piece of information must be repeated to the caller at least once for QA purposes
What is: The callers name
When an injured worker is calling to inquire about reimbursement they should be referred here?
What is "DOL" / CE
This particular claim will come through with a begin and end date
What is a short form closure
You can use one of these 4 criterias to search for a claim in Universe
What is: Name, Sub ID or Encrypted ID, Case ID or SSN as a last resort
If you are unsure what a particular block means, you can refererence this in the SOP for a detailed explanation of a block
What is: DOL Reject Reasons and Retail Pharmay Directions
You must obtain and document this specific information when HIPPA on a claim is received
What is: Title- HIPPA Authorization and date HIPPA received
Person who provided HIPPA Auth
If permission is granted for another party
If permission is granted to leave a detailed voice mail with specific phone number
What are the 6 acceptable pieces of PHI
What is: Claim/File Number, PBM Member ID, Last 4 of SSN, DOB, Full Address, DOI (if no other PHI can be verified)
When a Pt/Pharmacy is calling to request a Refill Too Soon what pieces of information are required to be included in the email to Fed Assist
What is: Destination, Departure Date, Return Date, Name of medication, Qty & DS
You would refer a provider here that is calling with questions regarding medical billing
What is Acentra Medical Billing
If notified by Department of Labor QAM or CE that a claimant is having surgery the associate should send what information to leadership through email
What is: Claim Number, Surgery Date, Comments, Callers (Name, Title, and Phone Number)