General
Where can I find the carrier number also known as the level 1 code.
Member center screen under eligibility tab
Which criteria would I choose for this phone number 855-240-0536?
FA-PA
Per you Assigned WI what is step 13?
Verify physician info
If the questions are answered incorrectly on the criteria can I update the information?
Yes, you can edit to ensure all information is correct and accurate.
When making an obc I can hold 2 minutes?
False, 1 minute
What WI can I find the specialty drug list?
#005035
I have a request for an opioid, it rejects 70 days out does it need a new pa?
No, we only run opioids for 60 days
If I have a new request never has been faxed out and my obc to mdo unsuccessful what is my next step?
Always notate unsuccessful obc and fax out
Per WI of I'm missing the MDO fax number what default can I use in case of missing MDO fax?
999-999-9999
If your able to approve a case on a call which time stamps would you use?
You would set to now for completed date and verbal notification date
If I wanted to give feedback on Smart Routing which WI would I use?
066028
When running a test claim for Dupixent you get the rejection number 866-814-5506, who handles this rejection?
Specialty
Why is it important to update the drug in the drug drop down field?
To ensure the macros populate and the wildcard
In duplicate denial, I have a case that needs to go to appeals handled by CVS, what are my next steps?
Download criteria, pa details, any attachments and RightFax to appeals using transfer to appeals coversheet
We always need to make a note of who we spoke to, first name, last initial and title?
True always notate who you spoke with
Where can I find the denial letters?
Communications Tab
If I have a reject 70 without a phone number and exceptions does not handle request per RMT then I know my request is an ___
IBR- Initial Benefit Review
Before forwarding to the Rph we always need to have what?
Completed timestamp
Per smart routing I need to verify my criteria, if the criteria is wrong I need to abort the case?
False, update to correct criteria and fax out with clinical using the RFI incorrect criteria option
If the MDO requests the criteria to be faxed, do I need to put my completed received date when faxing out?
No, only when forwarding to the RPH
Where can I find the outcome of the request?
In PA HX under resolution
After running my test claim and inputting my rejection number and phone number, no criteria is available what should I do?
Send to Sr box (email template) for missing criteria
Who are the two clients that have to have a diagnosis code entered on pa?
Carefirst and HMSA
If the request asks for documention do I need physical chart notes?
No, documentation can be given in the answer box or verbally.
What information can we leave on a voicemail when making an obc?
patients name and pa number/our callback number