Pharmacy - Part 2
Quiz by Ashley Jones
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- Q1
What is another name for Rx Nova, the system in which you can see is the member is currently in the Coverage Gap?
PA Hub
CSIM
Humana Drug List
Rx Call Connect
60s - Q2
Under which drawer in the Rx Nova (aka Rx Call Connect) Claims section would you be able to see which Tier level the member's medication is under?
Errors & Messages
Drug Information
Benefit
Pricing
300s - Q3
Where would you find the medication the member is taking in Rx Nova (aka Rx Call Connect)?
Claims
SharePoint>Humana Drug List
Benefits and Eligibility
Formulary
120s - Q4
In what line on the Claim Detail screen within Rx Nova (aka Rx Call Connect) can you view whether the medication was processed as a Part B or Part D?
Post Pay 4
CSIM
Benefits
Post Pay 3
120s - Q5
What does claim status "REV" mean?
Reversed
Rejected
Re-verified
Paid with Error
120s - Q6
Under which section in Rx Nova (aka Rx Call Connect) can you find the reason that the medication was denied?
Pricing
Drug Information
Errors & Messages
Benefits
120s - Q7
What happens in the event that a member receives a rejection when they go to pick up their prescription at their local pharmacy?
They will have a $0 copay.
Nothing--the claim is supposed to receive an error to be processed.
The member will need to visit their PCP to obtain an new prescription.
The claim for the medication has been denied and they will need to call CPHP to identify the reason.
120s - Q8
A Refill Too Soon (RTS) is a type of ______________________________.
Coverage Determination
Transitional Policy
internal jargon that should not be used with the members.
Eligibility Error
120s - Q9
Select the Coverage Determinations types that require the Formulary Exceptions path to obtain a supporting statement.
Non-Formulary, Quantity Limit, Tier Exception, Duplicate Therapy, Drug Interaction
RTS, CMS Excluded, PA, Non-Formulary
Quantity Limit, Duplicate Therapy, Prior Auth, B vs D
RTS, B vs D Drugs, Duplicate Therapy, Tier Exception
120s - Q10
Which Coverage Determination provides the member the option of answering their own medical questionnaire if needed?
Refill Too Soon
PA Coverage Determinations
Quantity Limits Exceptions
Exception Coverage Determinations
120s - Q11
Which EOC does NOT reflect a "denial" on PA Hub?
Tier Exception
Quantity Limit
Non-Formulary
Refill Too Soon
120s - Q12
What is the timeframe for prescribers to respond with their supporting statement?
30 days
7 days
28 days
14 days
120s - Q13
After receiving a response form the prescriber, CPHP will make a determination as expeditiously as the member's health requires, but no later than:
7 calendar days if urgent/14 calendar days if standard
72 hours if urgent/14 calendar days if standard
72 hours if urgent/7 calendar days if standard
24 hours if urgent/72 hours if standard
120s - Q14
Who is responsible for assisting the caller with completing the questionnaire?
The ICR
Production Lead
Pharmacy Department Tech
Frontline Leader
120s - Q15
A member calls after going to his pharmacy and being charged a high copay for his medications. The member stated he cannot afford the copay and he know that he would not qualify for LIS. What type of Coverage Determination would you process in this case?
Tier Exception
Step Therapy
CMS Excluded
This is not an example of a Coverage Determination
120s
