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WorksheetsPAC Training 3: Benefit Verification + RxHome Screen Set Up
Total questions: 25
Worksheet time: 13mins
The Patient Portfolio is most used
To communicate with patients
To access referral docs like prescriptions
To view eligibility check information
To update patient information in ESD
Prescriber information will tell you most about
The patient
The doctor
The diagnosis
The HUB
This icon is what to click when:
Accessing the Patient Portfolio
When checking and verifying accurate insurance information
A new record needs to be inserted
An ODT needs to be created due to no prescription being on file
True or False: 799 patients are in ESD, have Express Scripts, and are considered Mail Order patient.
True
False
On the Names Screen of RxHome, how must you proceed if it is blank
Fill each line manually based on the referral docs
Press the "Copy Patient Information" button first
Never Press the "Copy Patient Information" button
Skip the screen and unenroll the patient
As a default, on the Names Screen for Emp Status (employment status), we always select
9 - Employment Unknown
6 - Active Military Duty
1 - Full Time
4 - Self Empoyed
On the name's screen, if the patient is over 18, which box should be checked as you add the patient name?
Just the "Financially Responsible" box
Just the "Representative?" box
Both "Financially Responsible" and "Representative?" boxes
Neither "Representative?" nor "Financially Responsible" box
On the name's screen, if the patient is UNDER 18, which box should be checked as you enter the parent or guardian's name?
Just the "Financially Responsible" box
Just the "Representative?" box
Both "Financially Responsible" and "Representative?" boxes
Neither "Representative?" nor "Financially Responsible" box
As shown on the Medical Screen, what is another way to describe the ICD-10 code?
The doctors number associated with their practice
The patient's relation to the policy holder
The code to access their medicine
The diagnosis code
On the MISC Screen, all of the following might be selected as the Place of Service except for
1 - Pharmacy
11 - Office
12 - Patient Home
22 - Out-Patient Hospital
On the Status Screen, what piece of data should you ensure matches this screen, the Medical Screen, the Insurance Screen, and the User Flags Screen?
The Therapy ID
The Referral Number
The Active Therapy Start Date
The Pharmacy Status
On the Status Screen, if the DSA Flag is not checked that means...
Accredo has limited ability to communicate with a patient due to no consent signature
Accredo has limited ability to communicate with a doctor due to no consent signature
Accredo has limited ability to communicate with the HUB due to no consent signature
Accredo has limited ability to communicate with Insurance Companies due to no consent signature
From the PIC, the first action a rep should take to begin their investigation is:
Using the listed phone number to communicate with the patient
Click "Eligibility Check" button to run a check of current benefits
Use listed number to call payor to determine benefits
Click ODT button from menu to request referral documents and prescription
"Provides for the delivery of Medicaid health benefits and additional services through contracted arrangements between state Medicaid agencies and managed care organizations (MCOs) that accept a set per member per month (capitation) payment for these services," best describes what type of Insurance plan:
Straight Medicaid
Commercial
Medicare Part D
Managed Medicaid
Dummy Claims can be ran in RxHome without payor approval for all of the following except for:
Straight Medicaid
Managed Medicaid
Medicare Part D
Commercial Insurance Plans
Which of the following are a Medicare Part D coverage stage? Select all that apply
Deductible
Initial Coverage
Coverage Gap (Donut Hole)
Catastrophic
Out of Pocket Max
Should a dummy claim be run in RxHome without specific payor approval for Straight Medicaid coverage?
No
Yes
This is the Patient Information screen, which can be accessed from the PIC screen by
double clicking the Patient ID Number
zooming into the Patient Name
double clocking the patients name
clicking the "insert record" icon
Using the Patient Information screen, which of the following pieces of information is not directly accessible?
Service Branch
Patient Address
Patient Phone Number
Patient Insurance Claim Center Number
Need By Date
Which of the following options signify a default address for a patient? Check all that apply.
HOME
HOME(D)
SHIP
SHIP(D)
If a patient's SHIP(D) address is a medical facility, what additional address information must be filled out? CHECK ALL THAT APPLY
Medical Facility Box is checked
Include fax number in the comments section
Company Name
Contact Name (L,F)
To update an address in the Patient Information screen, after selecting the "TYPE" box, the next step is
Clicking the drop down arrow
Typing the new type of address
Clicking the green "insert record" button in the toolbar
Clicking the "enter query" button in the toolbar
Which screen, accessed easily through "Details" from the menu bar, allows representatives to enter the ICD-10 diagnosis code and corresponding therapy type?
Insurance Screen
Medical Screen
Therapy Screen
Name Screen
On the Patient Information screen, which of of the following is field used by clearance reps or reimbursement reps to communicate with Pharmacy employees information regarding therapy information, Prior Authorization information, and SB information?
Attention
Comments
Delivery Instructions
Specialty Instructions
On this Name's screen, what is the issue if Guari Pawar, MD is the current prescriber for the patient's therapy?
No issue - prescriber is entered
MDO is in as sequence 4 and should be sequence 1`
MDO needs a fax number to be entered
