A
Member called in requesting for Smart Summary. What is your Classification and Intent?
A.Communication and Touchpoint Non-Transfer B. Communication and Fulfillment C.Communication and Explanation of Benefits D.Communication and Smart Summary
A. Communication and Smart Summary
If the member is requesting to cancel an order from any doctor call queue, what is the TAT to remove the order request
48 hours
What type of request should you use for mailed/faxed forms if it is incorrect item received?
A. Verify Image Request
B. Image Pull Request
C. Show Forms Request
D. Image Request
B. Image Pull Request
How many days from the order's ship date must be referred before sending OTC Escalation?
How many days from the order's ship date must be referred before sending OTC Escalation?
A. 30 days
B. 45 days
C. 70 days
D. 60 days
D. 60 days
Auto Refill program automatically ships refill of the member's maintenance medication to them when they have used certain percentage of their orders. If the member is enrolled for auto refill. how many percentage that the refill automatically ships
85%
What is 141 Rx Nova error code?
A.Drug is Excluded on Plan Formulary B.Duplicate Claim C. National Drug Code (NDC) is not on file D. Obsolete NDC on Date Filled
A.Drug is Excluded on Plan Formulary
Copay consent allows HP who have credit cards on file. To set high price alert the copay amount must be no less than how many dollars?
$30
What should you do if member says he/she supposed to get 3 bottles of Rubbing Alcohol instead of one (1)?
A. Send SRT Request
B. Coordinate to Clinical Services
C. Process Reship at the OMS/Epost
D. Process Escalation Request
C. Process Reship at the OMS/Epost
You are placing OTC order over the phone with the member. When you calculated the total order it exceeded the OTC allowance. What will you advise to the mbr?
A. Ask member if he/she would like to attach the payment card on file.
B. Tell the member you will select bill payment later.
C. Advise member you will use his/her future OTC allowance
D. Ask member to cancel the order and call back on the next quarter.
A. Ask member if he/she would like to attach the payment card on file.
for cancelling an RTM request via transferring case to Doctors call, Select _ from the topic dropdown.
A. RTM
B. Doctor Calls
C. Fax Follow up
D. Humana Pharmacy
C. Fax Follow up
Member called in and ask about the account credit TAT for a refund request submitted to Finance. You will advise that it will take___.
A. Three to 5 days B. One or two weeks C. Up to seven days D. Up to two weeks
D. Up to two weeks
If an order was routed to the copay queue and member accepted the full copay but declined to attach a cc, what will happen to the order? and how many days the order will be canceled?
7 Days
Member called in wanted to know when will be the expiration of her unused OTC funds that carries over?
A. December 1st
B. December 31st
C. December 29th
D. January 1st
B. December 31st
If member calling in to get a refund from Humana for his OTC that was not process over the phone. What should you tell the member?
A. Sure, I can call our Finance Team to further help you.
B. Please go to our Humana Pharmacy Website to request refund
C. Participating retailer where you bought items handles refunds.
D. Get the OTC card numbers and connect to Finance Team.
C. Participating retailer where you bought items handles refunds.
Example of PILL ID request Except:
A. "My pill is different size/color"
B. "My Pill has different coating.
C. "My pill has a different marking"
D. "My pill was melted"
D. "My pill was melted"
How many days do we have to wait for a possible reship request from the day it was shipped?
A. If it has 7 or more days B. If it has 10 or more days
C. If it has 5 or more days D. If it has 14 or more days
B. If it has 10 or more days
What template or request are you going to use if the member would like to cancel an order in qmsi.
SRT
Member called in wanted to place OTC order however you've found out member has zero OTC allowance left. What should you advise to the member?
A. Advise member he/she already used his/her benefits at this period and cannot place an order at this time.
B. Ask the member if he/she has a charge card so you can place the order.
C. Advise member he/she can place the order and it will get shipped out when the next quarter comes up.
D. Advise member he/she can place the order at this time for free.
A. Advise member he/she already used his/her benefits at this period and cannot place an order at this time.
Below are prescription status that can be filled except for:
A. Expired
B. Renew
C. Work Rx
D. Refillable
C. Work Rx
What type of Argus denial is being handle by PAP team?
A. 268
B 517
C. 153
D. 367
B. 517
Which statement is TRUE about expedited shipping.
A. Expedited shipping only shortens the shipping time, not the time it takes to process the order before shipping it B. Expedited shipping shortens the time to process the order before shipping it C. Expedited shipping shortens the time to process the order and the shipping time D. Expedited shipping shortens does not deliver to international addresses
A.Expedited shipping only shortens the shipping time, not the time it takes to process the order before shipping it
If the member is requesting for an invoice for specific order last month, in what part of CRM are you going to check?
Invoice request
Member called in would like to know if he/she can use his/her Solutran card for Humana Pharmacy supplies? What will you advise?
A. No. It's only applicable to your local pharmacy
B. Yes. You don't have to use your Solutran card because it's free in Humana.
C. No. Your Solutran card doesn't meet our maximum required allowance.
D. Yes, after the card was activated.
D. Yes, after the card was activated.
A. All valid RTM request except:
A. Alchohol BD swab with change of meter
B. Prescription filled from Local Pharmacy and no records found under member's CWP Account
C. Change doctor's name
D Quantity Change
A. Alchohol BD swab with change of meter
refills order can be placed online or via CenterWell Pharmacy Mobile App. by phone. or by mail. refills are available either when the member has a ___ days supply remaining or has 75% of their medication
22 days supply