Posnet
CIS
What is a compounding pharmacy?
Compounding pharmacies can customize dosages or formulations (usually at request of physician and for use by an individual patient).
When does premium billing run?
10th of each month
How many days past due will the account be terminated?
30 days (for CHIP)
Medicaid eligibility is determined using what?
Income and household size in comparison to income limits
How many digits are in a recipient ID number?
9
What are participating specialty pharmacies?
Chartwell, Accredo, UPMC Falk Pharmacy, and UPMC Hillman Cancer Center Pharmacy
What is GoVolution?
The IVR system to make a payment over the phone
How many days past due can a member make payments to reinstate their account?
90 days
Wages, interest, dividends, social security, veteran's benefits, pensions, spouse's income (if living together)
How do you get back to the menu?
enter "cqmenu' in the next trans field followed by "+"
What are formularies?
List of drugs covered by an insurance company.
Where should you process initial payments?
ACI
Who must Medicaid contact to update demographic information?
CAO (County Assistance Office)
What are some examples of income not counted when determining eligibility?
SSI, food stamps, foster care payments, housing/utility subsidies
The member's address can be found in what screen?
Case screen
What are the copays for full-cost CHIP for a 30 day supply of generic drugs and brand name drugs?
$10 - generic
$18 - brand name
What's the time frame for a refund?
4-6 weeks
Who can Medicaid members call to enroll in a plan?
PA Enrollment
What does MAWD stand for?
Medical Assistance for Workers with Disabilities
What does the "Lock In" field indicate on the Individual Managed Care Information Screen (Eligibility Screen)?
If a member is locked into one particular Pharmacy or PCP.
"N" means member can change pharm/pcp.
"Y" means member needs to write a letter to UPMC or call member services requesting a change
Who makes up the clinical team that chooses the formulary and how often do they meet?
Doctors, nurses, pharmacists, and our medical director, 4 times a year.
Where can you find a member's payment history in MC400?
Customer Status Screen and then Display Details
Name 3 ways a member can enroll with UPMC.
Electronic enrollment - COMPASS
Paper enrollment forms
Sign up through a Broker
Sign up through Sales
Medical providers are required to enroll and meet credentialing requirements through a program called _.
PROMISe