MEDS
You can use this shortcut to search the formulary faster...
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This system you are able to check and see if a member is covered for Lyrica?
ESD or UPMC Health Plan
This is the system that you are able to check if a member is dual eligible...
POS Net
Code used when submitting a grievance in MC400?
GCA
ODAG timeframe for pre-service, expedited decisions take
72 hours
This operates as mail order warehouses and dispense only certain types of medications?
Specialty Pharmacies
This health plan allows members to go out of network, but usually has higher cost-sharing amounts for doing so.
PPO
Document that lists medication , tiers, and prices?
Formulary
This code is use to document that there are no Gaps in Care in MC 400...
GIC950
ANOC- Annual notice of change
This is the cost, per 30 days, of Tier 2: Preferred Generic Drugs
$10
The dates when all people with Medicare can change their Medicare health plans and prescription drug coverage for the following year to better meet their needs?
October 15- Dec 7
Able to find a member's currently submitted appeal and view what stage of processing it's in?
MED Hok
This code is used for when documenting a member having a question regarding prescription
MCR002
Amount that a member can be reimbursed for quarterly activities.
$25
Proces when a drug moves tiers on the formulary but a member on a fixed income requests it to stay the same
Tiering exception
This plan comes with a HAS(health savings account)
HDHP
Where you can document creditable prescription coverage
LEP Verbal attestation Sharepoint
Code used to document that a check was not approved in MC400
R-ACH
The 4 other states that are being added to the UPMC for life visitor and travel program in 2019...
GA, NC, SC, AND TN
These drugs aren't self administered by the patient and are injected or infused while receiving physician, hospital, or outpatient service
Part B Drugs
This plan has an over the counter card with an allowance of $125 per quarter.
UPMC for Life Dual SNP
This is where you can view information regarding OON vision reimbursements
AS400
This is where you can find details that need included when documenting an ODAG in MC400
KIP-Medicare Documentation Templates
or Health Planet
In health planet you can find things like diabetic case management, general case management, and MTM (Rx Ante) information
Condition Center