Benefits & Insurance
What is this a definition of:
Federal health insurance for anyone age 65 or older, has qualifying disabilities (under 65), or has End Stage Renal Disease (ESRD).
Medicare
Where can you find the acquisition method for your case?
Pulse/BV Tab
Enrollment Form
What job aid has all your call scripts?
Tezspire ELog
Where do we go to find the active providers for a case?
Care Team
Define the process of confirming a patient’s insurance coverage, including eligibility, cost-share responsibilities, and authorization requirements, to ensure proper access to treatment and accurate billing
Benefit Verification
When verifying pharmacy benefits, do we call the PBM or the Specialty Pharmacy?
PBM
The only available acquisition method for Pharmacy Benefit requests is Buy & Bill. True or False?
False.
What are all your must-have daily tools?
Tezspire NPT,
Tezspire eLog,
& Tezspire and Bone Combined Blurb Tool
The button to 'Log a Call' is found on the program tab. True or False?
True
Name the three coverage stages of Medicare Part D in order.
Another word for Government Insurance
Public Insurance
The specialty pharmacy acquisition method is NOT an option for Traditional Medicare. True or False?
True
What job aid has the Specialty Pharmacy phone & fax numbers as well as the IDN list?
Tezspire and Bone Combined Blurb Tool
On what tab would you create a program coverage tab, if one was not already created by eBV?
Health Plan Tab
Name this coordination type:
Secondary covers 100% of remaining costs
Come-Out-Whole Coordination
If the Pre-Filled Syringe is selected on the enrollment form and we only have Pharmacy insurance on file, do we send the case to missing information?
No, verify for pharmacy benefits
Do we obtain Specialty Pharmacy information from the secondary insurance?
No
What job aid has your call log template?
How to Log a Call in Pulse
On what tab(s) are you able to review the most recent inbound document for a case?
BV tab,
Program tab
Name this coordination type:
Secondary plan only covers a percentage of costs
Standard Coordination
For the Pre-Filled Syringe, if no benefit type was selected but we have both medical & pharmacy insurance on file, what benefit type are we verifying for?
Medical & Pharmacy
If no acquisition method is selected on the enrollment form for a Pre-Filled Pen, and we have BOTH medical and pharmacy insurance on file, what acquisition method are we defaulting to?
Specialty Pharmacy only
What job aid does the Tezspire eLog refer you to if you want to know more about non-duplication plans?
Benefit Verification Best Practices
Most things on Pulse, like the care team or diagnosis code, cannot be found in multiple areas. They are only found in one spot and nowhere else. True or False?
False
What is the official list of medications approved by an insurance called?
Formulary