Commercial Jeopardy Jeopardy Template

Authentication	Prior Authorization	general info	overrides
100 Name, date of birth, zipcode, and one of the following(name of medication, ID#, rx#, MBi# if medicare) What are the 4 pieces of info you must get on a NON -IVR call?	100 By running a test claim How do you determine if a prior authorization is needed?	100 7 business days What is the TAT for an initial Benefit Review?	100 manual refill task What is the task you utilize when unable to place a refill via website, ivr or peoplesafe?	100 PBO What is the tab you use to enter an override for mail order?
200 Name & date of birth What do you need to verify from the member on an IVR call?	200 The hours are Monday through Friday, 7:00am to 8:00pm CST what are the hours of the Prior Authorization dept?	200 An appeal is a dispute to have a product covered with their prescription benefit when it normally is not. Anyone can file for an appeal and it doesn’t have to be done by a physician. what is an appeal	200 Arkansas, Nebraska, New York, Utah, Puerto Rico What are the states that do not qualify for bridge supply?	200 submit a PBO task or contact senior What do you do if your are unable to enter an override using the PBO tab?
300 Member first and last name, Date of birth,zip code, one of the following (rx name, rx#, member ID, MBI if medicare AND callers name What info do you need to verify if a Dr office calls in on a non ivr call?	300 A prior authorization, also called a PA, is a step used to determine if the medication your healthcare provider prescribed is safe, effective, and appropriate given the options available for a condition what is a prior authorization	300 The IBR request generates a letter to the member explaining the coverage of the medication and how to appeal. what does the IBR request do?	300 Bulk up What is the process if a member was expecting a 90 day supply but only got a 30day supply and is requesting the remainder?	300 Run a test claim What is the final step for entering an override?
400 Callers first and last name,Member first and last name, Date of birth,zip code, one of the following (rx name, rx#, member ID, MBI if medicare and 3rd party question What info do you need to verify if a member is calling in for her dependent who is over the age of 18 on a NON ivr call	400 AFTER completing the IBR task, inform the member verbally of the appeal process “To file an appeal, ask your prescriber to fax a letter of medical necessity to the Appeal department at 1-866-443-1172.” what do you do after you complete the IBR task?	400 Maintenance Choice is available at any of our Retail CVS pharmacies including those inside of Target stores, as well as through Home Delivery/Mail Order pharmacy. Where can a member fill Maintenance Choice meds?	400 add PBO on bottom of page What is the tab you click if you have a rejection at retail?
500 members first and last name, Date of birth,,zip code, one of the following (rx name, rx#, member ID, MBI if medicare AND callers name and NPI # What information do you need to verify if a pharmacist calls in on a NON ivr call	500 advise member : ” Have your doctor clearly mark ‘urgent’ on the letter of medical necessity and fax to 1-866-443-1172. Turnaround time is 72 hours.” How does the member have the appeal be urgent?	500 Mandatory- No choice ,must use CVS/mail order and get 90days at a time Volunatary- doesn't have to use CVS/Mail or get 90 days but IF they choose to they will save $ and may even get it free Incentivized- your price will be higher and may keep rising until you switch What is the difference between Mandatory Maintenance choice, voluntary maintenance choice and Incentivized maintenance choice?	500 flip the Maintenance choice button to YES what extra step do you need to do for an override on a maintenance choice med?

Commercial Jeopardy

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