Medicare EGWP 1PS

Question 1

True or False : Pharmacies must submit two claims when working with an EGWP member - one for Med D and then a COB claim for the Wrap.

Answer 1

False. Navitus MedicareRx uses one processing solution, which automatically runs a single claim through both the Med D benefit and the Wrap benefit.

Question 2

True or False : If a claim pays through Med D it will automatically pay through the Wrap

Answer 2

False. Claims may pay through Med D and reject on Wrap and vice versa.

Question 3

True or False : The Wrap claim displays the final copay the pharmacy sees.

Answer 3

True.

Question 4

Wrap claims will always show _________ information, based on what the Med D claim paid.

Answer 4

“Other Payor” information

Question 5

If you ask a pharmacy to submit an OCC you should look at the _____ claim

Answer 5

“Med D” claim

Question 6

You can identify the Med D claim from the Wrap claim by _____

Answer 6

Comparing the Group # listed on the Claim Response tab - The Wrap claim will have a “w” (or an extra “w”)

Question 7

MRXWIE is the ______ Group while

MRXWIEW is the ________ Group

Answer 7

Med D

Wrap

Question 8

MRXSSCW is the ______ Group while

MRXSSC is the _________ Group

Answer 8

Wrap

Med D

Question 9

If Med D denies the claim, and the Wrap pays, what will the pharmacy see?

Answer 9

A Paid claim.

Question 10

If Med D Pays and the Wrap denies a claim, what will the pharmacy see?

Answer 10

A Paid claim.