Document
If member calling in to ask stage their Eliquis went to where do I document this?
A. Medication inquiries
B. Form Status Inquiries
C. General Pharmacy Inquiries
D. Transition of Care Inquiries
A. Medication inquiries
Which stage does member pay only a coinsurance for their cost of share?
A. Deductible
B. Coverage Gap
C. Catastrophic
D. IC
B. Coverage Gap
If member has a question about how much Eliquis 5 mg medication will cost at the pharmacy I will use:
A. CCM Search Tool
B. Benefit Explorer
C. Care Connects
D. ESI
D. ESI
I only need ___ letters to search a medication in the formulary.
A. 2
B. 4
C. all
D. 3
D. 3
Where in CSP can I see the co pay for a medication a member had filled last month:
A. Drug coverage
B. Account summary
C. Benefits Overview
D. Claims- patient summary
D. Claims- patient summary
Member calling in because they were told at the pharmacy Medicare is not their primary payor. Where should I document this?
A. Transition of Care Inquiries
B. Medication inquiries
C. General Pharmacy Inquiries
D. Medication Denial Pharmacy/Processing issues
D. Medication Denial Pharmacy/Processing issues
The benefit stage that requires a member to pay their own medication cost until they meet a threshold level is:
A. copay
B. IC
C. Deductible
D. Coverage Gap
C. Deductible
The ingredient cost submitted is:
A. Medication cost before Wellcare intervenes
B. How much Wellcare was approved for
C. How much the member has to pay
D. How much Wellcare has to pay
A. Medication cost without Wellcare
If a medication is not covered under Medicare the formulary will display ____
A. excluded
B. NF
C. it will not bring up medication
D. alt meds
C. it will not bring up medication
Where in CSP can I see which benefit stage the co pay for a medication was applied?
A. Drug coverage
B. Account summary
C. Benefits Overview
D. Claims- patient summary
B. Account summary
Member is requesting the co pay for a medication they want to bring to the pharmacy. I see that medication has a PA restriction. Member state they will discuss this with doctor and call back. Where do i document this?
A. Form Status Inquiries
B. Medication inquiries
C. General Pharmacy Inquiries
D. pharmacy Network
B. Medication inquiries
What benefit stage is cost of share based off tier of medication?
A. Deductible
B. IC
C. Coverage gap
D. A & B
E. B &C
F. A & C
G. none of the above
D. A & B
If member has a question about how much a tier 1 medication will cost at the pharmacy I will use:
A. CCM Search Tool
B. Benefit Explorer
C. Care Connects
D. ESI
B. Benefit Explorer
I can determine if there is an alternative medication for the member by looking at the:
A. notes/restrictions
B. status
C. name of medication
D. therapeutic class
A. notes/restrictions
Where in CSP can I see an alternative medication for a member's medication
A. Preferred Products
B. Account summary
C. Benefits Overview
D. Claims- patient summary
A. Preferred Products
Member calling in because they are going on a trip to Brazil next month and need their pharmacy processing information? Where do I go if I only want to provide member the information and document?
A. Transition of Care Inquiries
B. Medication inquiries
C. General Pharmacy Inquiries
D. Medication Denial Pharmacy/Processing issues
C. General Pharmacy Inquiries
What stage requires a member to pay a copay or coinsurance?
A. Deductible
B. Coverage Gap
C. Donut Hole
D. IC
D. IC
Client billed amount is :
A. Medication cost before Wellcare intervenes
B. How much Wellcare was approved for
C. How much the member has to pay
D. How much Wellcare has to pay
D. How much Wellcare has to pay
I can determine if a medication is a vaccine by looking at the:
A. notes/restrictions
B. status
C. name of medication
D. therapeutic class
D. therapeutic class
Where in CSP can I see if medication is covered or excluded?
A. Preferred Products
B. Account summary
C. Coverage Notes
D. Claims- patient summary
C. Coverage Notes
Member calling in because their medication was a tier 4 but they request the tier to go lower and want to check if their medication is now on the lower tier. Where do I document this?
A. Form Status Inquiries
B. Medication inquiries
C. General Pharmacy Inquiries
D. pharmacy Network
A. Form Status Inquiries
What benefit stage is cost of share based off brand/generic medication?
A. Deductible
B. Catastrophic
C. Coverage gap
D. A & B
E. B &C
F. A & C
G. All of the above
E. B &C
The cost approved is:
A. Medication cost before Wellcare intervenes
B. How much Wellcare was approved for
C. How much the member has to pay
D. How much Wellcare has to pay
B. How much Wellcare was approved for
If a medication is not covered under a Wellcare plan the formulary will display ____
A. excluded
B. NF
C. it will not bring up medication
D. alt meds
B. NF
If running a test claim for an unbreakable package i should place the quantity as _____.
A. 1
B. Depends on how often they are taken medication per day
C. What populates when I am doing drug coverage check
D. the number the member provides
C. What populates when I am doing drug coverage check