Across
- 1. system we use to look up tier levels of medications, formulary alternatives, PA initiation form and the Client Services Referral Form
- 4. LIS
- 5. makes a compliant note for Grievances and Coverage determinations.
- 6. Explanation of benefits and system generated letters are viewed from this system
- 8. System we use to view results of Coverage determinations, flip alternate insurance flags, and update LIS information
- 9. trainer
- 10. BAE
- 13. Medicare's database we use to verify member demographic information and LIS levels.
- 15. The Part of Medicare that handles Medications
- 16. OOA
- 19. document we MUST use in mySME whenever their is a medication REJECTION on the members account within the Pharmacy tab inside the Accountsummary, in order to figure out how to deal with the rejection code
- 23. Generic for Levoxyl
- 24. PDP
- 25. tier 2 customer service
- 27. type of coverage determination that requires doctors input
- 29. PDP639
- 30. Id card, formulary, coupon book, COB survey.
- 31. either put HIPAA verfied, or HIPAA not verified only
- 32. COB
Down
- 2. When a member is reported as deceased, but is not.
- 3. CSRF
- 5. MIIM
- 7. brand for alprazolam
- 11. Only LIS that can have lower than 100% subsidy
- 12. employer
- 14. ilead
- 17. Health Insurance Portability and Accountability Act
- 18. PDP623
- 20. C13
- 21. System we use to view documents sent by memebers
- 22. Thank you for calling unitedhealth care, my name is Bob, may I have your name please?
- 26. type of grievance that is filed when a members complains about their pharmacy doing something to the member that would impact the members health(fill the wrong medication, the wrong amount etc..)
- 28. type of grievance filed when a member is complaining about the Agent that enrolled them into their plan(ex: when I was enrolled into the plan the agent didn't tell me that!