Show:
RxHD
Plans
Piller
Edits
Misc.
100
If a claim does not meet the insurance plan’s processing requirements, it will cause a(n) ___________.
What is a rejection
100
To find who is authorized to update member information, handles Prior Authorizations or can order ID cards click this tab.
What is Plan Contacts?
100
A limitation or condition for coverage of a medication is an____.
What is Edit?
100
Additional Rejection 88 DUR information is found here high dose alert, drug interactions and refill to soon.
What is Submitted Drug Utilization Review?
100
A pharmacy can enter this to allow a claim to pay without an override?
What is Submission Clarification Code (SCC)?
200
If a ID card is pending what message will display?
What is" An ID card request is already pending?"
200
Where can you find the proper infomation about processing compounds.
What is compound ribbon?
200
Where can you do a side-by-side comparison of the pharmacy’s submitted information.
What is Pharmacy Transmission Information Comparison?
200
A member LIS (low income subsidy) information can be found in the Account Info panel and ___?
What is Member Info Panel?
200
You can find information regarding flu vaccines, covered OTC's, Smoking cessation and Diabetic programs here
What is Programs ribbon in benefits?
300
Wrong DOB, wrong gender, incorrect BIN, PCN or Member number are examples of.
What is Tranmission error?
300
This button must be pressed before you can document and save a call?
What is ACVD?
300
The accumulator used to show when a member reaches coverage gap is?
What is Drug Spend (TDE)
300
You can find information on Medi-Span, RxCLAIM Formulary Status and RxCLAIM drug edits by clicking this.
What is GPI number search function?
300
You can find this information in member notes?
What is Prior Authorization and DMR information
400
Where can you find information about previous calls to CSA's?
What is call history?
400
If you click the copay tier button on the claim pricing screen you will go to?
What is Copay section of the Plan Benefits Information?
400
Information about drug classification, manufacture and bottle size is found on the _______ screen?
What is Product?
400
Giving information that you think they would need to know or that answers questions they havent thought to ask is acting...
What is proactively?
400
Pricing for a Brand Medication is taking the AWP and multiplied by this?
What is Quantity?
500
When a member is added to RXHD what information is needed?
What is ID, Carrier Account and group number
500
What information can you find in the Medi-span information?
What is the maximum dosage for adults?
500
If a member questions the total price of a drug, or is concerned that a co-insurance is not accurate which pricing column
What is Client pricing column?
500
Network Pricing is a method of pricing in which the client is charged _________.
What is More for a claim than the pharmacy is reimbursed?
500
The statuses for Prior Authorization are?
What is Pending, Canceled, Approved and Denied?