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BEING A CSA
IRIS
EDUCATION
OUR MEMBERS
ETC...
100
The process a doctor has to go through to obtain approval for a member from the plan.
What is Prior Authorization?
100
An authorized representative with a HIPAA task on file is required to provide 2 of what 3 things to authenticate themselves?
What is Full name & 10 digit phone number or zip code
100
What is the 11 digit number that identifies a medicine called?
What is NDC?
100
What is the acronym for Low Income Subsidy?
What is LIS
100
When a member has 2 or more insurance place what has to takes place.
What is Coordination of Benefits? or COB
200
What is a day supply?
What is number of days it will take the patient to finish medication?
200
When must a doctor complete a renewal form?
What is when a prescription has expired or has no refills
200
The abbreviation "mg" stand for ____?
What is "milligram"
200
What is the 3 ways OptumRx accepts prescriptions?
What is Mail, Phone and Email?
200
Coinsurance is when the cost of medical services is shared by
What is the insurance company and the patient
300
A controlled substance (CII-CV) resend request is handled by?
What is Consulting Pharmacist?
300
A preliminary determination that no benefits will be paid on a claim is known as a
What is Rejection?
300
A brand name drug is one that is ___?
What is Patented?
300
The guardian of a minor wants to order the child's prescriptions, What member information must be authenticated?
What is Member's full name, date of birth, and complete address?
300
Where in compass can you find job postings?
What is you can't? It's not listed.
400
On the SOF, Outbound call notes can be viewed when the patient returns the call by
What is clicking the paperclip with the yellow slip of paper on the toolbar?
400
Adjudication is the process of
What is determining the amount of the claim that will be paid
400
How are tablets, capsules, creams, and ointments measured by?
What is grams?
400
A customer must test their blood sugar before each meal and also at bedtime each day. A box of 100 test strips will last this customer ____ days
What is 25?
400
MCG is equal to ____ of a GM?
What is 1/1,000,000 or one Millionth or a gram.
500
What is the problem? What do I need to know? Where will I find the answer? Asking these type of question is a good way to??
What is solve a problem
500
Processing claims using more than one coverage plan is known as
What is coordination of benefits
500
One gram contains _____ milligrams
What is 1000?
500
If the cost of a prescriptions is $150, the deductible is $30, and the copay is $20, the amount to be paid to the pharmacy by the PBM is_____
What is $100
500
For an order to adjudicate the medications on a refill order and return pricing, it is necessary to _____.
What is "BOOK" the order?