RX Claims
MSA Tool
FUN FACTS
The HUB
Our Clients
100
What is the 3 letter acronym used to enter into the RX Claims system?
What is RXJ
100
Where on MSA can you find what kind of plan a member has?
What is the BET
100
What does S.O.A.R Stand for?
What is Spark Curiosity
Once Team Once Direction
Action for results
Right by Right Purpose
100
Based on the MSS/HIPPA Guide, are we allowed to disclose if the plan is commercial or not to third parties?
What is Providing the information whether the plan is commercial or not falls under "Eligibility and Health Plan Information" which is not allowed to be disclosed.
See: "STOP: NO other information can be released including but not limited to: Eligibility and Health Plan Information, Health Care Information"
100
Is there a specific greeting for PHD FL Blue?
What is no.
200
What F Key is used to display the member info?
what is F5 or 5
200
Under what tab can you find members phone #'s?
What is Preferences.
200
What is HGS Healthcare's new name?
What is Sagility.
200
Where would it show in the HUB who to contact if the doctor is requesting another denial letter? (provide the link)
200
For BCBS of New Mexico Who handles the initial PRIOR AUTHORIZATION request for Dr Office.
Who is Prime PHD.
300
What does F24 do?
What is More info
300
To run a quote for a medication what do you need?
What is name and strength of medication and NDC.
300
When was Prime's first day of taking calls?
What was 12/20/2021
300
On the Call Transfer Guidelines link, what should we do if there is a longer than normal wait when transferring your caller to another department?
What is We are experiencing longer than normal hold times, because of this we are implementing a two minute hold process for ALL clients and Pharmacies.
How to Handle It:
If you are connecting the caller to the Client or an external department and the hold time exceeds ONE minutes after navigating through the IVR:- - Inform the caller that there is a longer than normal hold time
- Advise the member that you will transfer them into the queue and the next available representative will be able to help address their question(s)
- Provide the phone number dialed to the caller for future reference
- Advise the caller they may need to share personal information again with the new representative to access the account to help
300
For BCBS of Texas can you process a lost/Stolen Medication Override for a non controlled substance?
What is 
For Fully Insured and HIM:
- Deny request as lost medications are not part of the member's pharmacy benefit.
For ASO Group:
- Create a Prime Resolution Case:
Managing group: Account Management
Request Type: Plan Limitations / Drug Covg / Qty Limit
Include: date of service, drug name, and specific details about the situation
400
When Reversing a claim what F key do you enter to Submit Reversal?
What is F18
400
What are 3 ways you can look up a member in MSA tools.
What is Name and DOB, ID and Phone #.
400
Who is our director of operations?
Who is Chris Melton?
400
What job aid states that we cannot offer to do prior authorization's over the phone unless the provider asks?
400
For Regence BCBS Oregon What is the process for an override Dosage Change?
What is If NEW prescription has been presented, override may be entered as appropriate.
If there is a quantity restriction or prior authorization required follow the Utilization Management process
500
To lookup a members copay in Rx claims from the Member Detail screen, place your cursor on the Group number and press what hotkey on the group?
What is F4
500
What is the price quote process on MSA Tools?
Use quote tabs, type name of medication and strength, enter monthly, quantity and press "get quote" from there you can provide mail order or retail pharmacy pricing.
500
Other than the USA what other country takes Prime PHD calls?
Who is Jamaica or off shore team.
500
Are we supposed to treat someone as a third party if they're calling as a representative from the member's health plan? If not/If so, where is that listed?
What is No. The MSS/HIPPA Guide.
Examples of Health Care Providers include, but are not limited to:
- Doctors
- Clinicals/hospitals
- Psychologist/Psychiatrist
- Dentists
- Chiropractors
- Nursing Homes
- Pharmacies (including mail order and online pharmacies, ex. PillPack)
- Health Plan representatives from the member's plan (ex: BCBS-MN calling for BCBS-MN member)
500
For BCBS Illinois for a vacation override international for the second request less than 90 days what is the process?
What is
- > 90 day supply/Controlled Substances:
- Create a Prime Resolution Case:
Managing group: Account Management
Request Type: Plan Limitations / Drug Covg / Qty Limit
Include: date of service, drug name, itinerary with all questions answered below
- Create a Prime Resolution Case: