Terms
How can we enter F13 in RxCLAIM?
State the first four things you should validate when reviewing a case after you've searched for the member in Rxclaim?
Full Name, Date of birth, address and Member ID
What are the three choices for recommended outcome in CMM?
Granted, Not granted and Other
How do you know when to page down in RxCLAIM?
There will be a + sign displayed at the bottom of the screen
ePA request passes through single intake team
False
What is referred to as the hot key in RxCLAIM?
F4
State one way which requests can be submitted into CMM
ePA request
Fax Request
MyPrime
Phone In
What is the purpose of the F4 in RxCLAIM?
It shortcuts to another screen to display additional information hidden behind pink text
How do you get rid of an error message in RxCLAIM?
Press ctrl to reset
The billed coverage will always be set as Pharmacy in CMM
True
What does "Shift + Tab" do?
Moves the cursor backward
State the default PA type in RxCLAIM unless indicated in the Program Specific Guidelines
GPI PA
What should you press to search the member by name instead of member ID?
F15- Shift + F3
What does F12 do in RxCLAIM?
It is used to return to the previous screen
The program type is found in the Additional Review Information section in a CMM case
True
What does the date 12/31/39 represent in RxCLAIM?
It is the indefinite date
State one section in CMM that will have case notes to determine the final outcome?
Attachment Section, Task List Section and Notes Section
What Macro can be used to pull information from CMM into RxCLAIM?
Member Search Macro (Ctrl + M)
Why is it important to take notes before entering your PA?
Many reasons- answer will be accepted once it makes sense
1. Helps you to stay organized when entering your PA
You will be allowed to select Recommended outcome in CMM even if some required tasks are not checked off
False
What does the option key "2" do?
Allows the editing of a record
Why do we search if the member has an alternate address?
To ensure PHI is sent to the correct location per the member's right
What Macro is used to find out if there has been confidential communication in RxCLAIM?
Confidential Communication Macro (Ctrl -)
Does mirroring mean to place quantity detailing in the same fields as the GPI/NDC list shows?
(Yes/No)
yes
True Claims in RxCLAIM has a T in the middle to indicate that they are True Claims
False; Test claims have T in middle