Let's Keep it a Secret!
HIPAA and PHI
What is the Health Insurance Portability and Accountability Act? What is Personal Health Information?
You don't eat at this table, but you will find the cost of medications.
What is the copay table?
POP
What is the Prescription Optimization Program?
Who is Dustin Lee?
Assign the Role dropdown to PA Team.
What is the action taken when creating a Prior Auth ticket to ensure the PA Team receives it?
Member Name
Member Date of Birth
Member Medication List
What are examples of Protected Health Information?
There are no hardcover or paperbacks in this library.
What is the Salesforce, Member Services library?
This is one of the two new POP Team Supervisors.
Who is either Angel Lamber or Eric Bryant?
What is participate in meeting theme, teams meeting backgrounds, wear CerpassRx swag?
Actions taken prior to Creating a New PA Ticket.
What is?
confirm who handles Prior Auth's
perform test claim with current date to confirm rejection
check for existing tickets
If this box is checked in Salesforce member profile, we can release information to the authorized person(s) on behalf of the member.
Where is the HIPAA form received location?
***Daily Double***
Where is the HIPAA form, we send to members stored? (specific)
They say the early bird gets the worm, but if members do this too early, they get one of these.
What is a reject 79 Refill Too Soon?
These are the hours for the Prescription Optimization Team.
What is 8:00am ct - 7:00pm ct Monday through Friday?
*Announcements are sent out regarding changes.
This is the newest way to recognize and send a shout out to a team member. as well as view savings on fun activities.
What is Nector?
Salesforce Member Profile Stentor PA Button, Tredium Member Profile Ticket Search, JMT.
What are all the places Prior Auth information can be seen?
***Daily Double***
What is the new enhancement added to the Prior Auth process as of March 3rd?
We do this whenever a call is transferred to us.
What is re-confirm PHI?
The BDT Administrative Information Section gives Refill too soon approval info for Lost, Stolen and Vacation as well as this additional type of override.
What is Refill too Soon for dosage increase?
When a POP medication test or production claim rejects "75 Prior Authorization Required" this is the next step.
What is Member Service Agent follows steps in the Create a Ticket process?
The CEO and COO of CerpassRx.
Who are Greg Buscetto and Eric Yonkus?
This information specifically is provided to callers once we create/initiate a Prior Auth ticket along with the ticket number, before ending that call.
What is Prior Authorization turnaround times?
-24 to 72 hours for Standard Prior Auths
-24 hours for Urgent Prior Auths
-Timeframe starts when fully filled out forms are received back from MDO
Examples of information we can provide to 3rd party callers, as long as they confirm PHI.
What is?
Processing information (BIN/PCN)
If a medication is covered
If a medication requires a Prior Auth
If member is active or termed
The Age Modifier, Copay Modifier, Refill Modifier, and the Benefit List Name Causing Reject fields are all found on this Tab of the Claim Information screen.
The is the Claim Fields tab?
Provide caller with the appropriate Prescription Optimization Team contact number and provide hours of operation.
What is the process for calls needing POP assistance after hours, on weekends or any time POP Patient Advocates are not available?
CerpassRx was built on these Core Values.
What are Collaborative, Accountable, Passionate, and Empowering?
When we see this Prior Auth ticket resolution, we transfer the caller to POP.
What is a Resolved Ticket/Prior Authorization "905 POP Approved"?