Program/Groups
How much should the patients income level be equal to or below the current Federal Poverty Level to meet the financial requirements?
7 times or 700%
What is the RX Bin number and what is the processing code number?
Rx BIN: 610600
Processing Code: 08
What must a patient have to be reimbursed?
PNC Card
What is the deadline for 2023 claims is?
March 31st 2024
When is the circumstance an agent can send out a paper application?
If the the patient is re-enrolling
What is conducted to determine a diagnosis verification to confirm eligibility?
Audit
Which two case types must an agent change case owner?
Name update and income inquiry
What is the spending restrictions for the PNC card?
None
What are the three types of claim?
Pharmacy
Medical
Reimbursement
What is the name/color of the virtual assistant?
Purple
What are the two types of coverage groups?
Co-pay and financial
Name all of the case status that must be submitted for approval?
Termination
Therapy request
Program recommendation
Plan benefit inquires
When is the PNC automatically ordered for the patient?
Once a reimbursement claim is created.
What are co-pays based on?
What is the co-pay amount for Group 01 and 02?
IncomeGroup 01-$0 Group o2-$10.
What information must a patient insert online to check their waitlist program status?
Last Name DOB and waitlist pin number?
What are the 3 types of program status?
open waitlist and closed
Who will reach out to the primary insurance provider to confirm coverage?
Claims Specialist
What is the minimum age for a patient to have a PNC card?
15 or older
Pharmacy receipts are acceptable POP if it includes the following?
Invoice/drug label with RX
What does an agent select for when completing the Lighthouse Pre-screen answer the describing yourself?
I am a pharmacy provider
What is the difference between acute and chronic diagnosis types?
Acute: Abrupt onset of diagnosis, rapidly progressive, and short duration
A chronic disease is ongoing. Most of our funds fall into this category.
Which two types of audits are initiated by management but are normally triggered automatically based on the claim amount?
Diagnosis and Insurance
How long can it take up to from the order date for the PNC card to be delivered to the patient?
Up to 2 weeks
What are the 4 pieces of billing information are required for a pharmacy claim
Member ID
Group
PCN
BIN
List at least 4 different methods a patient can use to re-enroll?
Online
Cell phone with a QR code
email link
paper application