Authentication
What a person has to have on file via verbal consent to get a deceased member's information.
What is an Executor of Estate (EOE)
No LIS on file
What an is Edit 7?
Where we update the member's demographics
What is the PEDM screen?
Pharmacy using Umid getting a rejection.
what is a 002/076 or 002/495 error?
Limited Income Newly Eligible Transition Program
What is LINET?
The elements to authenticate a Provider or a Pharmacy
What is the Provider's tax ID or NPI and the Provider's Name or Name of Facility
Another Part D Plan on file
What is an Edit 3?
Where we Authenticate a member's Demographics
What is Marx?
Pharmacy trying to run a claim for 90 days or more
What is a 033 error?
When a caller request retro date of service and are eligible to be added
What is Dynamically adding?
Can be given to a caller who has not been fully authenticated.
What is general information?
No Medicare Part A/B/D coverage on file
What is an Edit 2?
When member enrolled in an LINET plan, or they are no longer in LINET, but the issue or concern happened while enrolled.
What are G&A Rights?
pharmacy getting a claim too soon rejection.
what is a 080 error?
U&C Cost is too High Pharmacy must submit below the cost shown
What is the 372 Error code?
Someone who represents a beneficiary
What is a Personal Representative?
What is an Edit 6?
where we create a work task in CI
What is PATR?
Pharmacy getting rejection stating they need to run the claim below $98.67.
what is a 372 error?
Member wants to term LINET coverage and it's before the start date of the plan.
What is a Cancellation?
Do you give me a onetime consent to srelease your personal health information to ______ and also give _____ consent to make any changes on your behalf?
What is our Verbal Consent Verbiage?
No US Adress on file
What is an Edit 8?
(regarding G&A)
These are sent to HCPR
What are denied Prior Authorizations or denied DMR Request?
Pharmacy getting rejection to submit to hospice
What is a 297/444 error?
Letter received showing member is past their 60 day grace period
What is the Unconfirmed Letter?