RxClaims/Formulary Viewer Knowledge Check
RxClaims/Formulary Viewer Knowledge Check
Welcome to the RxClaims/Formulary Viewer Knowledge Check! This quiz is designed to assess your understanding of the RxClaims system and related processes. It covers various aspects such as member search, authorization management, and drug-specific criteria.
- Test your knowledge on key fun
ctionalities. - Enhance your skills in handling authorizations.
- Prepare for real-world scenarios in the healthcare field.
After member search has been executed, before selecting the correct member, what information should be verified before proceeding to member profile?
First and Last Name
DOB
Carrier #
Coverage dates
All the Above
What F-key is used to search or retrieve additional information, known as the “Hot Key” when applicable?
F3
F6
F4
F12
When entering an Authorization, what ‘Reason code’ is the most common code and used for all routine authorizations?
DT
MC
ME
MB
When editing an authorization also known as maintaining an Authorization, what status (‘Sts’) code is used for most Part D Auths?
Lowercase m
Uppercase K
Uppercase M
Lowercase j
For Ondansetron, How far back do you wildcard the GPI?
GPI 10; Back 4 digits
GPI 12; Back 2 digits
GPI 8; Back 6 digits
GP I14; Not wildcarded to allow for specific dosage and form
What information needs to be populated in order to run a successful Mock Claim from Scratch?
Proc Ctrl, Facility ID, Claim Date, NDC#, Disp Qty, Day Supply
Proc Ctrl, Pharmacy ID, Claim Date, NDC#, Disp Qty, Day Supply
Proc Ctrl, Pharmacy ID, Claim Date, GPI#, Disp Qty, Day Supply
Proc Ctrl, Facility ID, Claim Date, GPI#, Disp Qty, Day Supply
For a Trillium Advantage member, on which account would we enter a Non-Formulary Authorization?
Primary
Secondary
Both
Maintaining an Authorization: Place 99999 in Daily Dose Max Column with an “S” in the Hot Keyed “Daily Dose Qual” Field, What Auth type requires this edit?
Age Restriction (Age Limit)
Financial QL
Max Dose (Safety Limit) QL
STCOB
Synthroid 125mcg tabs was approved until 12/31/18, DAW 1. Which Auth type would you follow according to Desktop 17?
Part D Auth 01
Part D Auth 02
Brand Name Medically Neccessary Auth 01
Brand Name Medically Neccessary Auth 02
From the Display Member Details screen, which F-key selection will provide the option to view ESRD information?
F7
F10
F16
F8
Once Mock Claim has been submitted, what F-key option is used to verify claim is paying against your Authorization?
F7
F15
F17
F10
What does the icon ‘HNMC’ mean in formulary viewer?
HealthNet Medicaid Eligible
Medicare excluded, Medicaid Eligible
Medicaid excluded, Medicare Eligible
HealthNet Medicare Eligible
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