Intro to Optum Rx

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Slides 1-19

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Tiffany

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Intro to Optum Rx

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Intro to Optum Rx


Froggy Jumps Intro to Optum RxVersion en ligne Slides 1-19 par Tiffany 1 What does Optum primarily provide to support pharmacies? a Insurance claims processing solutions b Retail pharmacy staffing c Patient prescription delivery 2 What is MedRx? a An Optum platform for billing medical claims from the pharmacy system b A pharmacy inventory system c A clinical decision support tool 3 Where is a claim sent after it leaves the pharmacy’s software? a To the Optum system b Directly to the payer c To the patient 4 What does “adjudication” mean in claims processing? a Determining whether to pay, deny, or pend a claim b Submitting a claim c Correcting a rejected claim 5 Edits are designed to help maximize pharmacy profit by reducing denied or unpaid claims. a True b False c 6 What is the primary role of a software vendor in a pharmacy setting? a Capturing pharmacy claim data b Adjudicating claims c Paying pharmacy claims 7 Usual and Customary is also referred to as what? a off the shelf price b Product Identifier c The brand the plan will pay for 8 What is a Channel Partner? a A software vendor that re-sells MedRx services to pharmacies b a pharmacy c An Insurance company 9 If the Channel Partner is a reseller of MedRx services, Optum has a contract with the Vendor/Channel Partner, not directly with the Pharmacy. a True b False c 10 Can a pharmacy bill through our services if they are not enrolled? a No b Yes c 11 Does a Paid claim in Allwin guarantee a pharmacy will be reimbursed or paid for that claim? a No b Yes c Only on days that end in Y 12 Is a pharmacy required to have an NCPDP? a Yes b No c Sometimes 13 Is a pharmacy required to have a ptan? a Yes b No c Only during a leap year 14 Are any of the claims that run through our MedRX platform “live”? a No b Yes c Only if the pharmacy uses the "live" button. 15 Which services are commonly billed as professional claims? a DME, immunizations, and some specialized medications b Over-the-counter medications c Only medications 16 What type of pharmacy claims does Optum process? a Professional – Clearinghouse/Medical Claims b Standard – Prescription Claims c Government claims 17 What does the NDC identify? a Manufacturer, product, and package size b Insurance plan and payer c Pharmacy location 18 What is the primary role of a clearinghouse? a Check claims for errors before sending them to the health plan b Pay healthcare claims c Enter prescription data 19 Which identifiers does Optum use to recognize pharmacy customers? a Pharmacy NPI or NCPDP number b DEA number only c Pharmacy license number 20 What does the plan use to identify the pharmacy submitting a claim? a PTAN b NCPDP c DEA Number

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Intro to Optum Rx

Froggy Jumps

À propos de cette activité

Créé par

Téléchargez la version pour jouer sur papier

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Intro to Optum RxVersion en ligne

par Tiffany

What does Optum primarily provide to support pharmacies?

What is MedRx?

Where is a claim sent after it leaves the pharmacy’s software?

What does “adjudication” mean in claims processing?

Edits are designed to help maximize pharmacy profit by reducing denied or unpaid claims.

What is the primary role of a software vendor in a pharmacy setting?

Usual and Customary is also referred to as what?

What is a Channel Partner?

If the Channel Partner is a reseller of MedRx services, Optum has a contract with the Vendor/Channel Partner, not directly with the Pharmacy.

Can a pharmacy bill through our services if they are not enrolled?

Does a Paid claim in Allwin guarantee a pharmacy will be reimbursed or paid for that claim?

Is a pharmacy required to have an NCPDP?

Is a pharmacy required to have a ptan?

Are any of the claims that run through our MedRX platform “live”?

Which services are commonly billed as professional claims?

What type of pharmacy claims does Optum process?

What does the NDC identify?

What is the primary role of a clearinghouse?

Which identifiers does Optum use to recognize pharmacy customers?

What does the plan use to identify the pharmacy submitting a claim?