Major Medical Task Quiz

What system(s) can we check eligibility when working with Major Medical Task?

• Enterprise

• People Safe

• Change HealthCare & Availity

• CAS

What is the source document(s) for Full Major Medical Verification & Major Medical Refill Patient?

• TSRC-PROD-013368 & TSRC-PROD-0412239

• TSRC-PROD-013366& TSRC-PROD-010820

• TSRC-PROD-013366& TSRC-PROD-041239

• TSRC-PROD-026243& TSRC-PROD-010820

True or False: While working a Major Medical claim the processing status, will return results as paid claim?

• False

• True

What system can you locate Payor file so we can verify if a Major Medical insurance requires a Prior Authorization for a specific medication?

• SPRX

• theSource

• Pharmacy Reference

• Specialty Admissions Database

Most Major Medical case requires a Prior Authorization?

• True

• False

What are the Source documents for Change Healthcare and Availity?

• TSRC-PROD-041239, TSRC-PROD-013349

• TSRC-PROD-026243, TSRC-PROD-010820

• TSRC-PROD-013375, TSRC-PROD-000630

What are the verification steps we must complete in the Pre-Dispense check for MAJ box before processing a claim?

• QTY=DS

• Benefit Check Complete, Existing PA on file or (No PA Required), Can Fill on or After Date

• Account number, therapy code, notes.

• Prescription Date

What BV Note template should we complete & category should we notate an MAJ Task in the notes?

• Major Medical Template & GEN

• Major Medical Template & BIL

• Prescription Template & BIL

• Major Medical Template & COB

Can we Process a Major Medical claim if the Can Fill on Date or After is a Future Date?

• True

• False

When adding New MAJ PA, what are the required fields.

• Prior auth Number, Effective date, Expiration date, NDC number or GPI Code, Received Via, QTY Limit (If available), Day Supply Limit (If available)

• Both options are correct

• Procedure Code, Place of Service, Approved Provider, NPI, Total Approved QTY, Total Unit Form, Total Approved Shipments