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Pharmacy - Part 2

Quiz by Ashley Jones

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19 questions
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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


    Humana Drug List

    Rx Call Connect

  • 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



  • Q3

    Where would you find the medication the member is taking in Rx Nova (aka Rx Call Connect)?


    SharePoint>Humana Drug List

    Benefits and Eligibility


  • 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?

    Question Image

    Post Pay 4



    Post Pay 3

  • Q5

    What does claim status "REV" mean?




    Paid with Error

  • Q6

    Under which section in Rx Nova (aka Rx Call Connect) can you find the reason that the medication was denied?


    Drug Information

    Errors & Messages


  • 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.

  • 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

  • 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

  • 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

  • Q11

    Which EOC does NOT reflect a "denial" on PA Hub?

    Tier Exception

    Quantity Limit


    Refill Too Soon

  • Q12

    What is the timeframe for prescribers to respond with their supporting statement?

    30 days

    7 days

    28 days

    14 days

  • 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

  • Q14

    Who is responsible for assisting the caller with completing the questionnaire?

    The ICR

    Production Lead

    Pharmacy Department Tech

    Frontline Leader

  • 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


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