Show:
HIPAA
ARGUS
RIGHTSOURCE/REFILLS
CALL TYPES
POLICY
100
I can use 3 of these 5 identifiers to authenticate a member.
What is Member Identification number Social Security Number Medicare Id number Member Date of Birth Member zip code Member group number
100
To do a member search, the Humana id goes in this field
What is Alternate Id field.
100
There are three places I can verify the shipping address in the right source rx call center tab
What is The right source header, View refill detail, and Order box.
100
For this call type, I would Refer to this document "Refills for Expired or No Quantity Prescriptions"
What is Create a refill order
100
GCP and OMS will reflect $70 on Medicare and Commercial members account if?
What is if the member has a card on file set to Auto Charge.
200
I can release PHI to an unauthorized 3rd party if I obtain Implied consent by gathering what ?
What is Obtain name of member, 3 identifiers and Authenticate the authority of the caller.
200
You check this date to access an active account.
What is Month/date/9999
200
The "Patient Not Found" message will display on this screen.
What is The right source Rx call center tab.
200
This call type and Job aid includes a document for Credit card Member V. Member rights.
What is Billing issues/ Call Center Working Billing Issues
200
A CCS cannot confirm a credit card, by reading the last 4-digits of the number and its expiration date to a caller, unless?
What is The Caller's name is on the credit card. Caller has authority from the member and the member's name is on the card.
300
There is a POA on file, which type can I not use to release PHI?
What is POA type U
300
This error code means the drug has a clinical criteria that requires review by HCPR, and I must follow this mentor document.
What is 082, prior authorizations request procedures
300
I want to fill this New prescription but it can only be mailed in.
What is New prescriptions for controlled (CII) substances (regardless of who is sending in the prescription) can only be mailed
300
In this call type I follow these steps to cancel all orders and Submit a request to inactivate refills and prescriptions that are on file.
What is Member is deceased
300
UPS and USPS are used for this method of shipment.
What is Overnight Shipping:
400
When is the Member's name not considered an element for authenticating the member identity?
What is when an Agent/broker calls on behalf of the member.
400
What radio button would I view to see the drug tier level?
What is Plan data
400
I take these steps in this order to access Humana pharmacy as the member.
What is Links, web registry-current member, enter Member ID number, Go to Humana pharmacy.
400
This Call type includes a document that explains how to assist existing members and providers with sending a prescription (Rx) to Humana Pharmacy
What is Questions (from current member) regarding how to submit new prescriptions to HP (fax, mail, ePrescribe)
400
What is the Suggested Scripting when associate is asked to supply his/her last name?
What is It is not our policy to supply last names, for the security and privacy of our associates, but I can give you the first initial of my last name which is __. I would also like to give you the reference number of this call. It is ______. With this reference number, any Customer Care Specialist can quickly and easily locate the information provided on this call.”
500
If email is the only practical means of conveying PHI, these are the precautionary steps you would follow.
What is A-Attach a password-protected file containing the-protected information B-Include only the minimum amount of protected C-information necessary D-De-identify the protected information Limit distribution to only those individual with a "need to know"
500
What does invalid NDC mean on claims list?
What is Part B claim.
500
I am having GCP system issue, I would need to complete the following if the order has not already been submitted.
What is A- Select Completed Still Open for the Status. B-Select the standard refill CRDs. C-Indicate in the Notes section if the prescription(s) are profiled, select check-box not available, etc Include the following in Notes: Member name, Humana ID number, and account number Shipping address (if different from the shipping address on file) Billing method (credit card or invoice). If billing by credit card then document the last four digits of the card and the expiration date. Ship method. Medication name, strength, and Rx numbers (if available) Special instructions, if applicable D-Select the following values: Priority: NORMAL Srv Ctr: Phoenix Dept: RightSourceRx Team: Sys Issue Refill E-Provide the appropriate delivery TAT (5-7 days for refills, 7-10 for new orders). Refer to the topic Delivery TATs. F-continue with normal call processing. Address any other HP needs the member may have. G-Go to the topic Before Closing the Call.
500
In this call type I find steps on how to Perform a test claim in ARGUS to find the AWP price.
What is Request for a Cash & Carry Order
500
If members insist on a refund or members can no longer use HP they can receive a refund. Refund turnaround time for:
What is Checks - 3-4 weeks from the time a refund request is created. Credit Card accounts: 3-5 business days from the time the request was submitted.