PHARMACY 1
A concerned member who is locked out of their account is trying to reorder their prescriptions.
a) Advise the caller you are going to unlock their account. Utilize CSR Password Reset to unlock their account
A PDP member is traveling across the U.S. to visit family and friends. Can they get their prescriptions filled in any state
Yes, they can use any Humana pharmacy or get a vacation supply before they leave if they have not exhausted their limit
When verifying prescription drug (Part D) benefits, where will you confirm if the member reached or is nearing their initial stage
RxNova Call Connect
A member expresses concern over the high copay cost of their prescription that their PCP states is the only effective medication for them.
Advise the member they can request a tier exception and warm transfer them to HCPR
How can you tell when a drug claim requiring correction was adjusted and reprocessed in RxNova Desktop?
A date is visible in the Adjustment date field.
Humana does not cover replacement of lost, stolen, or damaged medications. However, you (the advocate) can offer members some helpful suggestions.
e) Advise the member to file an appeal with the insurance company for a one-time exception
Members can choose to enroll in which Humana stand-alone prescription drug plans
Value, Basic, or Premier
) The Member ID link from this RxNova Call Connect button is launched if needing to review a member’s pharmacy accumulations from the previous plan year
Benefits/Eligibility
When researching a denied drug claim in RxNova Call Connect, you find error code “082” listed under the Errors & Messages panel, what does this mean
Pre-authorization is required through HCPR
The status of a prior authorization for a prescription drug can be found where in CRM
Auth/Referral Summary tab under Pharmacy Authorization tab
) According to the Medicare Immunization Coverage Reference guideline, how is the Pneumococcal vaccine covered?
Under Medicare Part B
Where in RxNova Call Connect is a member’s Low Income Subsidy (LIS) status located
Benefits & Eligibility Part D panel
When verifying prescription drug (part D) benefits in RxConnect, how can you tell if a medication is not covered
“Not Covered” appears in the Coverage column.
If, while researching a different denied drug claim, you notice error code “221” is listed in the Errors & Messages panel, what does this mean?
The medication is for a drug covered under Part B only
If the indicator under the RxNova Call Connect Dual Coverage panel shows “S”, what does this mean
The member has other insurance (OI) – Humana is secondary.
What is the only exception that would result in Humana covering a lost or damaged medication
A disaster exception
Where in CRM is a member’s Low Income Subsidy (LIS) status located? a) Person Account page – Communication panel
Plan Member page - Eligibility Information section
When viewing drug pricing results in RxConnect, what indicator represents the best deal for our members
Amount corresponding to the green dollar sign
When confirming the amount (if any) a member owes on a drug claim, which dollar amount in RxNova Call Connect represents the member’s responsibility
Patient Paid amount
Mail Order demographic Information edited under the Demographics section is limited to ____________
Contact numbers and email addresses
When addressing access to care issues (where members are unable to obtain their prescriptions when they need them), you must always confirm the member has enough medication to last how long
48 hours
According to the Extra Help/LIS Comparison guideline, if a member’s LIS status shows 1001, what subsidy level is this
Subsidy 3 and 4
When verifying prescription drug (part D) benefits in RxConnect, how will you know if a medication requires prior authorization approval from HCPR
“Prior Authorization”, “B vs D Determination”, or “Step Therapy” appears under the Coverage column
Which RxNova Call Connect option provides the status of check issued to members who submit a paper claim for Direct Member Reimbursement (DMR)?
Reimbursement
What information do you relay to the caller regarding ordered medication
Name, Dosage, Quantity, Day Supply, Next Fill Date and Remaining Refills