Acronym
SPRX is an acronym that refers to this.
What is Specialty Processing Prescriptions?
This team works to proactively re-initiate prior authorization 30-45 days ahead of the existing authorization date.
What is Re-Authorization?
This is an online knowledge base which stores our Work Instruction (WI), Job Aids (JA), and pharmacy announcements.
What is TheSource?
This is the commercial insurance that would occur if HMO and PPO met, fell in love, got married, and had a baby. Like HMO, the patient chooses a primary care physician; and like a PPO, the patient can seek care from out-of-network providers without a referral.
What is Point of Service plan (POS)?
In SPRx, when working BV you will select the Processing Queue, what sub-queue do you choose?
What is the Insurance Diversion Queue?
FEP is an acronym that refers to this.
What is Federal Employee Program
This BV Team works to research and resolve debt for claims we did not verify correctly or that did not have a valid prior authorization in place at the time of dispense.
What is Bad Debt?
The first thing a BV representative will always do is look up a patient in this system.
What is SPRx?
Comments that are user entered notes with member critical information.
What are Priority Comments.
The acronym OOP refers to this.
What is Out-Of-Pocket?
This team is responsible for researching and resolving claim rejections for existing and renewal prescriptions for existing patients.
What is the Refill team?
This is the system which provides you with available prescriptions history, insurance and demographic information for patients that have been enrolled in a CVS Health pharmacy including, Mail Order, Specialty, or Retail.
What is Enterprise Information?
What is a Formulary?
A ________ occurs when work requires further attention before you can go to the next step.
What is Diversion?
The acronym RCC refers to this.
What is Reimbursement Counseling Center?
This team handles all claims related to Anthem Pharmacy benefits, including but not limited to refills, new members, copay assistance, cost relief, etc.
What is CarelonRx?
This SharePoint contains pharmacy and therapy information, as well as forms and general information.
What is Specialty Admissions SharePoint?
This is a limit on a covered service or supply. A service or supply may be limited by dollar amount, duration, or number of visits.
What is Maximum Allowable Benefit?
The TAB in SPRx that allows non-management users to unlock themselves from a task.
What is the Maintenance Tab
The acronym DAW refers to this.
What is Dispense As Written?
This team works to correct claims not processed correctly in their system prior to dispense, as well as researching claims incorrectly processed post ship.
What is PrudentRx?
_________ houses faxed referrals, Prior Authorizations, and prescriptions.
What is Document Viewer?
This type of policy is designed to cover high medical expenses that are due to major illnesses or events. Workman's compensation is an example of this type of insurance.
What is Indemnity?
When looking at the SPRx screen ______ can be seen when clicking on the carrot.
What is the extra information?