A
This key command in the SOP will allow you to search for a specific word or phrase within the SOP
What is Ctrl F
These particular claims will come through with a begin and end date
What is a Short Form Closure
This is the master carrier code for DOL Claims
What is USDL
If a caller is wanting the direct number for Portal Support you would provide this number and Option
What is 1-833-332-2726 Option 4
You will transfer a caller to this Ext for DOL Home Delivery Recruitment
What is 392885
After searching you realize a claim is NOT in our system, what 4 pieces of information must you obtain to send to cssdol@optum.com not including the body of the email
What is Case ID, Callers Name, Title and Contact #
PART stands for ?
What is a Prior Authorization Request Template
According to the SOP what are at least 3 rejections that will Auto Web Enable to VP and or Clinical
What Is:
CheckMaxLifeQuantity •
CheckMaxLifeQuantityDetail •
CheckMaxLifeDays •
CheckMaxLifeDaysDetail •
CheckMedLimit •
CheckNewLongActingOpioid
According to the DOL SOP, this platform is the pharmacy benefits manager (PBM) system used by Optum to process prescriptions
What is Universe
The claim acceptance maintenance screen can be found using the key function command
What is Shift + B
To set up a conference call with Procare ( Our Translation Services) you would dial this number
What is 1-866-941-7878
When speaking with the caller for the first time or if not already documented on the file, we must be sure to ask, state and document the following:
What is:
1. At this time is there anyone you would like us to document as giving us authorization to speak to in regard to your file in the future?
2. Do you give us permission to leave a detailed voicemail message in regard to your file at in the future if needed?
The FECA program requires claimants to use at least this percentage amount of a prescription days’ supply before subsequent refills are allowed for prescriptions filled at a retail pharmacy
What is 85%?
The initial day supply limit of an opioid is ?
What is a 7 DS
After the IW has filled the initial 7 DS of their opioid on a non legacy claim what step must be followed and obtained in order for authorization to be considered ?
What is obtain a PARF from the prescriber
This reject occurs when the pharmacy is submitting a DEA or NPI number for a prescriber that needs to be added or updated in our database prior to processing.
What is Missing Invalid Prescribers ID
This reject/block occurs when the date of
service processed is prior to the date of injury.
What is Missing Invalid Date Rx Written
This occurs when a pharmacy is attempting to process a medication for days of supply that exceeds the authorized number of days left on the NDC.spec record (PARF).
What is NDC Not Covered Check DS Against End Date
This reject/block occurs when a prescription is attempted to be refilled at the pharmacy before the fill date.
What is Refill Too Soon
According to the DOL Case Status Matrix list "XX" stands for?
What is Destroyed Case
According to the DOL Reject Reasons and Retail Pharmacy Directions: Orphenadrine ER is allowed if patient has tried and failed cyclobenzaprine or (_____) what other medication in the past 180 days.
What is tizanidine?
This reject occurs when a pharmacy is attempting to process one or more medications that have the same therapeutic usage as one or more medications on file.
What is a DUR Reject Error
This reject/block occurs when a pharmacy attempts to process an NDC number that is not loaded in UniVerse (Medi‐Span) or where the pharmacy is submitting the 11 digits with the same number.
What is Missing Invalid NDC Number
This reject/block occurs when the pharmacy is not in Universe or the pharmacy is NOT submitting the NCPDP # correctly.
What is Missing Invalid Pharmacy Number
Aimovig, Ajovy, Emgality, or Nurtec are allowed for migraine prevention if patient has tried/failed (___) in the past 180 days.
What is a 1st line oral migraine prevention therapy