Optum MedRx Yes or No

Oui ou Non

(1)

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A series of Yes or No questions regarding the MedRx products for Optum.

Créé par

Tiffany

United States

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Optum MedRx Yes or No


Optum MedRx Yes or NoVersion en ligne A series of Yes or No questions regarding the MedRx products for Optum. par Tiffany 1 The Channel Partner page in Salesforce has MedRx services listed under BILL CHAIN, is the software vendor a reseller of MedRx products? Yes No 2 Can a pharmacy process a CGM transmitter separately from a CGM sensor? Yes No 3 An item was submitted by another pharmacy location of the same Chain as your current customer causing the claim to not process. Can you provide the name of that other location? Yes No 4 The DOS (Date of service) should reflect when the item or service was dispensed to the beneficiary. Yes No 5 Are agents able to link NDC's to HCPCS for drugs or medications? Yes No 6 If the claim status in CMU is blank, can a pharmacy reverse the claim? Yes No 7 Can a pharmacy reverse a claim if the claim status in CMU is S? Yes No 8 Suffixes (JR, Sr, II, III) should be entered following the patient's last name in the Last Name Field. Yes No 9 Do Optum Edits automatically make changes or adjustments to a claim? Yes No 10 The Date of Service and the Transaction date must match. Yes No 11 A rejected reversal in Transmission View is represented by the color blue. Yes No 12 Is a Pharmacy required to have a Clearinghouse? Yes No 13 A rejected response in Transmission viewer is represented by the color red. Yes No 14 Is Optum a Clearinghouse for MedRx services? Yes No 15 Are MedRx claims adjudicated in real-time? Yes No 16 A Paid response in Transmission viewer (TV) is not a guarantee of payment by the Payer. Yes No 17 An item was submitted by another unrelated pharmacy location causing your current customer not to be able to process their claim. Can you provide the name of that other location? Yes No 18 If a Prescriber is not enrolled in PECOS, can they write prescriptions for Medicare B? Yes No 19 Prefixes such as Mr., Mrs. or Dr. should always be used as part of the patient's name. Yes No 20 Once a claim uploads to a Payer, can the pharmacy make changes or reverse the claim as is? Yes No 21 If a claim is Rejected in Transmission Viewer, does that claim ever get uploaded to the Plan/Payer? Yes No 22 If a patient did not have Medicare A at the time of transplant, Medicare B will pay for the immunosuppressive medications. Yes No 23 Any HCPCS/NDC found on the NDC/HCPCS crosswalk confirms an item is covered by Medicare B? Yes No 24 Can support agent's perform a NDC to HCPCS link for CGM meters or supplies? Yes No 25 If a pharmacy submits a U&C that is lower than the MAC amount, does the pharmacy receive the full reimbursement amount allowed? Yes No 26 A Paid response in Transmission viewer (TV) is represented by the color green. Yes No 27 Are Support agents allowed to provide a pharmacy with a patients MBI or CHID number? Yes No

Optum MedRx Yes or No

Oui ou Non

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Optum MedRx Yes or NoVersion en ligne

par Tiffany

The Channel Partner page in Salesforce has MedRx services listed under BILL CHAIN, is the software vendor a reseller of MedRx products?

Can a pharmacy process a CGM transmitter separately from a CGM sensor?

An item was submitted by another pharmacy location of the same Chain as your current customer causing the claim to not process. Can you provide the name of that other location?

The DOS (Date of service) should reflect when the item or service was dispensed to the beneficiary.

Are agents able to link NDC's to HCPCS for drugs or medications?

If the claim status in CMU is blank, can a pharmacy reverse the claim?

Can a pharmacy reverse a claim if the claim status in CMU is S?

Suffixes (JR, Sr, II, III) should be entered following the patient's last name in the Last Name Field.

Do Optum Edits automatically make changes or adjustments to a claim?

The Date of Service and the Transaction date must match.

A rejected reversal in Transmission View is represented by the color blue.

Is a Pharmacy required to have a Clearinghouse?

A rejected response in Transmission viewer is represented by the color red.

Is Optum a Clearinghouse for MedRx services?

Are MedRx claims adjudicated in real-time?

A Paid response in Transmission viewer (TV) is not a guarantee of payment by the Payer.

An item was submitted by another unrelated pharmacy location causing your current customer not to be able to process their claim. Can you provide the name of that other location?

If a Prescriber is not enrolled in PECOS, can they write prescriptions for Medicare B?

Prefixes such as Mr., Mrs. or Dr. should always be used as part of the patient's name.

Once a claim uploads to a Payer, can the pharmacy make changes or reverse the claim as is?

If a claim is Rejected in Transmission Viewer, does that claim ever get uploaded to the Plan/Payer?

If a patient did not have Medicare A at the time of transplant, Medicare B will pay for the immunosuppressive medications.

Any HCPCS/NDC found on the NDC/HCPCS crosswalk confirms an item is covered by Medicare B?

Can support agent's perform a NDC to HCPCS link for CGM meters or supplies?

If a pharmacy submits a U&C that is lower than the MAC amount, does the pharmacy receive the full reimbursement amount allowed?

A Paid response in Transmission viewer (TV) is represented by the color green.

Are Support agents allowed to provide a pharmacy with a patients MBI or CHID number?