Quiz 3

When do we bypass a case?

• Medicare without Plan Exclusion Inquiry

• Commercial

• Included in Not Part D List - Cough and Cold Medications

• Included in Not Part D List - CGM

What sub-reason codes can we use to deny a case?

• DESI

• Infertility

• Diabetic Supp-Part A and Part B

• OTC

Can we merge with Pending-AppealsVerification?

• No

• Yes

Can we merge with Pending-Outreach?

• No

• Yes

Can we merge with Pending-OutboundCall?

• No

• Yes

Can we merge with Pending-MedicalDirectorReview?

• No

• Yes

Phone case scenario: Medicare 1 denial on file within 60 days.

• Create PA-Forward to AV

• Create PA-Pend to Rph

• Cancel as DRD

• None of the above

Fax case scenario - UHCE&I Commercial 2 denial on file within 180 days

• Cancel as DRD

• Pend to Rph

• Forward to AV

• None of the above

Can we rework a case using cash card / discount card account?

• Yes

• No

"Timely"

• Urgent

• Not urgent