Omeisha Confluence Quiz

What cases require a call tracking note and what sections?

• All Cases- Validate Request & Review Outcome.

• HCSC States- Validate Request & Review Outcome.

• Florida Blue Only- Review Outcome

• Texas & Illinois Only- Validate Request

For Auto Approvals we answer the criteria questions exactly as they are on the request form.

• False

• True

At what section in Confluence do we find details on running a test claim?

• Perform Review

• Validate Request

• Determine Program

• Case Identification

When should we add the approved quantity to Effectuation Details?

• When the case is approved and QL applies

• Always

• For HCSC States

• Never

What is a Program Specific Guideline for Ozempic/Rybelus?

• Wildcard 2: if within QL

• Wildcard 4

• No Wildcard

• Detail on the monthly side always

We should NOT add the provider address to Prescriber section, If the address fields are not populated.

• False

• True

What is our Effectuation Date in CORE?

• The authorization start date

• The 15th of the month we are in

• We can put any date to hold the space

• The date that the request was effectuated (entered into Rxclaim)

When should we enter Three authorizations for Wegovy?

• Within the QL and the GPI/NDC list that the claim is pulling is detailed

• Always

• Within the QL and the GPI/NDC list that the claim is pulling is NOT detailed

• When it is over the QL

What documents should be sent to MRIoA when doing a Pre Physician Review? (Select All That Apply)

• Current case file

• Other (information submitted with the request via the portal)

• PARQSTFRM (Request form)

• ADDLINFO (Additional information received)

• Most recent RPH criteria set

What QL field should be filled out if the plan has no QL or QL does not apply?

• Max Quantity Field

• Requested Quantity Field

• Quantity Units Field

• None