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WorksheetsMajor Medical Knowledge Check
Total questions: 10
Worksheet time: 5mins
What system(s) can we check eligibility when working with Major Medical Tasks?
People Safe
CAS
Change HealthCare & Availity
Enterprise
True or False: Most Major Medical case requires a Prior Authorization?
True
False
What are the 3 verification steps we must complete in the Pre-Dispense check for MAJ box before processing a claim?
Prescription Date
QTY=DS
Benefit Check Complete, Existing PA on file or (No PA Required), Can Fill on or After Date
Account number, therapy code, notes.
What category should we notate an MAJ Task in the notes?
GEN
TXT
BIL
IBC
True or False: Can we Process a Major Medical claim if the Can Fill on Date or After is a Future Date?
True
False
Where can you locate Payor file so we can verify if a Major Medical insurance requires a Prior Authorization for a specific medication?
Specialty Admissions Database
theSource
SPRX
Pronet Pharmacy Reference
Tue or False: While working a Major Medical claim the processing status, will return results as paid claim?
True
False
What is the source document for Major Medical refills?
TSRC-PROD-026243
TSRC-PROD-010820
TSRC-PROD-041239
How do we differentiate Major Medical (MAJ) and Pap Cards (MAJ)?
A. An external vendor that acts as a liaison between the manufacturer copay assistance program, patient, and pharmacy to offer the Prudent RX copay optimization program. vs PAP cards are provided when a patient is enrolled in a manufacture co pay assistance program and are strictly to be ran as secondary.
A. A health insurance that finances the expenses of major illness and injury. Billing does not occur online and is often referred to as “Paper Billing” vs An external vendor that acts as a liaison between the manufacturer copay assistance program, patient, and pharmacy to offer the Prudent RX copay optimization program.
A. A health insurance that finances the expenses of major illness and injury. Billing does not occur online and is often referred to as “Paper Billing”. Vs PAP cards are provided when a patient is enrolled in a manufacture co pay assistance program and are strictly to be ran as secondary.
What are the source documents for Change Healthcare and Availity?
TSRC-PROD-026243, TSRC-PROD-010820
TSRC-PROD-041239, TSRC-PROD-013349
TSRC-PROD-013375, TSRC-PROD-000630
