
CMM Confluence Review
Authored by Mitchell Training
Other
1st - 5th Grade
Used 1+ times

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10 questions
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1.
MULTIPLE CHOICE QUESTION
30 sec • 1 pt
If GPI list description includes NONCLNCL or DACON we would search for:
NONCLNCL Criteria set
Any Criteria set
Our specific program criteria set
General QL
Answer explanation
2.
MULTIPLE SELECT QUESTION
45 sec • 1 pt
WY doesn't review for:
Netresults Member
70 reject for NetResults account
70 reject for Commercial account
Standard Commercial
Answer explanation
3.
MULTIPLE CHOICE QUESTION
30 sec • 1 pt
We would select _________ question set for Reject 70 RXEX: Use (preferred drug name)
Coverage Exception Criteria set
Coverage Exception for ED meds
Drug Exclusion with Alternatives
Exception Criteria Closed benefit with ACA
Answer explanation
4.
MULTIPLE CHOICE QUESTION
30 sec • 1 pt
If NJ rejects for 75 and GPI list contains ST/QL our program type would be ?
Prior Authorization
Step Therapy
Smart PA
No Review Needed
Answer explanation
5.
MULTIPLE SELECT QUESTION
45 sec • 1 pt
We route to Pharmacist if :
Question set is incomplete
Outcome reasons have a denial point
Validation point labeled "Miscellaneous" in the Outcome reasons
There's a High Touch indicator
Answer explanation
6.
FILL IN THE BLANK QUESTION
1 min • 1 pt
When routing to closure we set Recommended Outcome to ______ and All Review info Received to ____
Answer explanation
7.
FILL IN THE BLANK QUESTION
1 min • 1 pt
KS only review for _____ CE cases
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