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UHC Final
UHC Final
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StudBud Administration
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Final
Flashcards
29 cards
F
Practice quiz
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Host live
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Questions
29
Answers
1
A prescription claim that moves through more than one benefit level is called?
Crisscross claim
Messed up claim
Crossover Claim
I don't know
2
What intent in MIIM would you use to verify that a member is in Coverage Gap?
Plan
Pharmacy
Review Rx Benefits
Member
3
What intent do you use to find out if a medication is covered?
Who knows, I'm still lost.
Pharmacy Look up
Call the pharmacy
Formulary Lookup
4
Therapy Class Alternatives means
I'm lost and have not clue.
Save on some of the most common drugs at select pharmacies.
Save money by switching to a drug on a lower tier
Offers Discounts on drugs NOT covered by Part D
5
Save up to 20% or more on Tier 1 and Tier 2 co-pays by using select pharmacies.
Drug Discount Card Program
Drug Manufacturer Assistance Prgram
Gieco
Pharmacy Saver Program
6
What intent in MIIM do you use to change a members address?
Update members Address
Update members profile
General Service Request
Send member to SSA
7
What tab would you find the members LIS copay category?
360 View
Plan
Account Summery
Member
8
Which diabetic supplies are covered under Part D
All of the above
Syringes
Insulin Pens
Gauze
9
Provider status Open means
Available for existing patients only
Available for new patients
Not available for new Patients
PCP is inappropriate for the members plan.
10
Can you filter the claim history results by paid/not paid?
Possibly
Maybe
No
Yes
11
When a member has additional insurance coverage, it's called
Dual Insurance
COB
Dual complete
Coordination of Benefits
12
If we do not have enough information, what should you do?
Tell the member you do not know
Hang up
Give up
Ask probing questions
13
What events will move a member out of coverage gap?
Reaches his TrOOP
Switch to a different plan
Applies for SPAP
Plan year ends
14
Member is upset that her PCP is OON, what should you do?
Submit an OD for continuity of care
Offer to submit an OD for gap exception
Submit a Verbal Grievance (VG)
Locate another provider or send provider directory for MBR
15
Define Drug Manufacturer Assistance Program
Provides coverage for specific medication
Offeres discounts on drugs NOT covered by Part D
Saves on some of the most common drugs at select pharmacies
Save money by swithching to a drug on a lower tier
16
When completing a VG for OptumRx, what additional step is required?
Escalate to Risk Management and complete COR
Refer member to CMS
Submit an entry on the Optum M&R VG Share point.
Submit an email to OptumRx complaint box
17
What Wizard should you use when the PCP is wrong
PCP Change
Quoting Benefits.
Contacts
Plan change
18
In OptumRx what function to you use to exit
F3
F7
F8
F12
19
Provider status closed means
PCP is inappropriate for the members plan
Available for new Patients
Available for existing patients only
Not available for new patients
20
You can see a members LIS level in MIIM 360 view
True
False
21
Provider status Existing Only means
Available for existing patients only
Available for new patients
Not available for new patients
PCP is inappropriate for the members plan.
22
Which diabetic supplies are covered under Part B
Blood sugar test strips
Insulin Pump (external)
Blood Sugar Monitors
All of the above
23
When submitting a RX VG, what additional step must be completed outside of MIIM
No other action needed
Send an email to the OptumRx complaint box
Escalate to Risk management and complete COR
Submit a SCRF to OptumRx
24
During a PCP change, you notice the PCP has been removed from the plan network.
We are downsizing our network & dropping Dr's
Im sorry that you been affected by a network optimization.
UHC is making some changes to our networks for better focus
This change will allow us to work more closely with Dr's
25
What vendor do we use for mail order pharmacy?
Walgreens
Optum Rx
RxOptum
Mail order pharmacy
26
If a member does not have multiple insurance you should
I dont't know.
Add notes in Rx Claim
Use the Rx COB Flag removal Marco
Change the alternate insurance flag in RxClaim to "N"
27
What is a Drug Discount Card Program
Provides coverage for specific medication if he meets income
Offer Discount on drugs NOT covered by part D
Allow him to save on some of the most common drugs
He could save money by switching to drug on a lower tier
28
If a member thinks Medicare should cover a medication that is not covered, what should you do?
Submit a VG
Offer a written response to member
Refer member to Medicare directly.
Recommend member to work with her Dr for a alternative med.
29
Provider status Restricted means
PCP is inappropriate for the new member's plan.
Available for existing patients only
Not available for new patients
Available for new patients
