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Claims and Pharmacy
Author :
Valery Avila
1.
What is the maximum of the Deductible?
A
$435
B
$445
C
$446
2.
What does pending mean?
A
Claim is being reviewed some discrepancy
B
Claim was rejected
C
Claim is suspended
3.
What is DMR?
A
Dual Medical Refund
B
Direct Member Reimbursement
C
Direct Medical Rx
4.
A DSNP member has part D ?
A
Yes
B
Maybe
C
No
5.
How many months does the member get disenrolled from part D if NPOP?
A
4 months
B
3 months
C
member never gets disenrolled
6.
What does the Umbrella symbol mean in Maestro?
A
Member has Part D
B
Member has Supplement Plan
C
Member feels blue
7.
Which of these pharmacies works only online?
A
Inkafarma
B
OptumRx
C
Walmart
8.
Which is the co/pay for the member in Initial Coverage Stage?
A
23%
B
5%
C
25%
9.
How to determinate the denied reason?
A
Reason Code/ description/ macros
B
Age and Plan Type/Knowledge Center
C
Member's income
10.
What does OOP mean?
A
Out of Pocket
B
Out of Payment
C
Out of Poket