Clinical Program Overview
what is step therapy
step therapy is a series of steps that must be tried in a specific order
this system is also known as
Thrasys
OLA stands for ?
what is.. On-Line Adjudication
MCA
Member care Advocate
what are reasons a QL is rejecting for
what is higher dose available, dosing higher quantity limits for max doses, test strips, & Narcotics
functions most commonly used are
call log, member, & clinical tickets
main screens used in OLA are
call notes, claims, clinical, overrides, CAP., deductible, and MOOP
CAE
Client Account Executive
call provider to send alternative script for preferred medications
what is step therapy
creator values are
what is.. the reason the ticket was created
process used to fax clinical over to provider
CM
prior authorization
utilizes online claim adjudication edits to prevent claim payment until the patient's drug history and/or current diagnosis has been assessed through communication with the member’s providers to ensure appropriate and safe utilization of the medication
main difference between the staging and real-time site
staging site has a red banner
call notes can capture
every interaction a member has had in regards to a specific inquiry id
COA
Client OPS analyst
name all clinical programs offered
PA, step therapy, QL,
follow ups are often moved out
what is ... 3 business days
in order to search for a member
client ID must be selected
head of clinical concierge services
Christina Lilley