Santa Clara Day 6 Review

When a member is requesting DMR (Direct Member Reimbursement), will they need to send in a copy of receipt of payment?

• Yes

• No

What demographic information are we able to update in QNXT?

• Name, Date of Birth, Gender

• Address, Phone Number, Preferred Language

• All of the above

• None of the above

When checking QNXT for Personal Representative on the account, should we also check for the effective and termination dates of the AOR?

• Yes

• No

When booking transportation, what does NMT mean?

• Non Medical Transport

• Non Emergency Medical Transport

• No Medical Timeframe

• None of the above

If a member is showing Deemed status for MediCal eligibility, are they able to book transportation?

• Yes

• No

When notating a call, should we include who we spoke with and their relationship to the member?

• Yes

• No

How long will it take for a member to recieve a replacement ID card?

• 5 days

• 7-10 business days

• 2 weeks

• 30 days

Under which hyperlink in QNXT are we able to view prior authorizations?

• Claims

• UM Documents

• Eligibility

• Calls

What is the name of the system we use to view pharmacy claims?

• Optum RX

• Transportation App

• QNXT

• MedImpact

When referring to medical authorizations or exceptions requests, what would we call this?

• Coverage Determination

• Balance Billing

• Organization Determination

• Authorization of Representative