Quantity
Requesting 1 tablet daily. Package size is 1000 EA
What is 30 tablets per 30 days?
Requesting 4 pens per month. Inject 0.75ML every week. Package size 0.75ML.
What is 3ML per 30 days?
There is a case for the same member, same provider and same medication and is currently approved until 8/7/2025.
What is a duplicate?
The member's exception group that uses CVS Standard Formulary?
What is Standard group?
When a case is a duplicate, you can do this action on the case.
What is Void?
Requesting 2 tubes monthly. Package size 45GM.
What is 90GM per 30 days?
1 capsule PO QD. Package size 100 EA.
What is 30 capsules per 30 days?
There is a case for the same member, same provider, same medication, and was denied within 180 days.
What is an Appeal?
This status is when the clinical information for a PA or formulary exception did not meet the criteria.
What is Clinical Review status?
When a case is a duplicate from more than 3 days ago, you should do this.
What is Resend Letter?
Requesting 1 vial every 4 weeks. Package size 1 EA.
What is 1 vial per 30 days?
Requesting 12 cans monthly. Package size 237GM.
What is 2,844GM per 30 days?
You should never appeal this status/type of medication.
What is Admin Deny?
The member's exception group that follows BCBS Formulary.
What is a Custom group?
When a medication does not require a prior authorization, step therapy, formulary exception, and does not exceed QCD.
What is a No PA?
Requesting 1 pen every other week. Package size 0.5ML.
What is 1ML per 30 days?
2 syringes per month. Package size 1.17ML.
What is 2.34ML per 30 days?
There are no other cases for the same member, same provider, same medication.
What is not a duplicate/new case/new review?
This status is when a decision is made and you must quality check the letters. Check that test claims pay with all approvals.
What is the Pending status?
This should never be your first option when you need assistance on your own.
What is the Supervisor Line (Sup line)?
Requesting 1 tablet every 8 hours daily. Package size 100 EA.
What is 90 tablets per 30 days?
Requesting 0.40ML syringe every week. Package size 1 EA.
What is 4 syringes per 30 days?
MDO started an EPA case and did not finish.
What is Questionset Sent?
When a medication must be dispensed by a contracted pharmacy, there is a drop down that must be selected.
What is CVS Specialty?
The folder(O-drive) where all workflows can be found.
What is Training Documents?