Confluence Knowledge Test 2

We always fill out these fields when No QL applies

• Max Quantity Field

• Quantity Units Field

• Requested Quantity Field

• None

When would we check for "CVS/Caremark"

• When a claim pays and Caremark is listed in BET under "Plan Information"

• When Caremark is listed in the Client Name in the summary details

• When the drug is found on the Florida specialty drug list and the member is not a SaveOn member

• When there is no claims for our requested drug in RxClaim

Which of these statuses are examples of "Open" cases? (Select all that apply)

• Open-MRIoA Submit

• Resolved-Approved

• Open-Outreach

• Pending-Outreach Tol

• Pending OutreachP2P

We check for TBO when

• The claim rejects for 75 and 76 at the same time

• There's a "O" present on our claim

• The Intake Note states

  TBO: Yes

• There's a pop up stating Note to Tech : TBO applies

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

• True

• False

To identify a compound drug the request form must indicate "Compound" as the requested medication and list the individual ingredients

• True

• False

Ctrl + Alt + 9 is used to run the call note macro

• True

• False

When should we add the approved quantity to Effectuation Details?

• Always

• Never

• When the case is approved and QL applies

• For HCSC States

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

• Current case file

• ADDLINFO (Additional information received)

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

• Most recent RPh criteria set

• PARQSTFRM (Request form)

When should we enter THREE auhtorizations 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