MPA
MPA stands for this.
What is Member Prior authorization?
What is prior authorization?
The system that let us know what charges are being applied for member's medication.
What is Transaction lookup?
The member must pay 100% of the contracted rate
What is deductible?
Rej 41
What is COB?
When doing a Vaction OR what box must be checked on your action tab.
What is Override Fill to soon?
This utilization management tool requires a member to try a preferred medication first.
What is Step Therapy?
The contracted rate for the medication.
What is LC is Calc?
The member does not have a deductible to meet what phase will they move into.
What is MOOP?
Medications that must be dispensed in their original container/package and cannot be opened or broken.
What is an Unbreakable package?
What screen do we pull up to locate an MPA that is already on file for member.
What is Member screen/Member options?
Theses notes are often requested to support medical necessity?
What are chart notes?
Populates when a claim meets a member’s MOOP
What is CopayCap?
What will be member's copays be once they reach moop.
What is $0 dollars?
Caller is calling in stating they are going on Vacation, What faq are you pulling up to assist caller?
What is FAQ Overrides Vacation?
This should be used every time you are going to enter an Override.
What is Workflow?
PA status will say this if provider is submitting pa for excluded medication.
What is cancelled?
An additional charge added when a covered brand
medication is chosen over a covered generic.
What is Cost sharing?
individual members covered under the same family plan receive the benefit once they each reach the individual Deductible/MOOP amounts.
What is embedded?
A provider is calling in regarding a not nc med, what faq would you pull up to assist.
What is faq Exception to Coverage (ETC) Process?
Claim is already on file for med per transaction look up, what button should I click to start my override?
What is create MPA?
A provider can sumbit this if they disagree with a Pa denial.
What is an appeal?
the dollar amount of the medication cost that is
being applied to the deductible for this claim.
What is CopayDeduct?
a plan with only one member (single) uses the individual amounts and a plan covering multiple family members uses family amounts only
What is non embedded?
Partners with drug manufacturers for certain medications to help reduce member responsibility
What is AGS?