Methods of Communicating the Prior Authorization Request to the Insurance Company

Question 1

Which method of submitting a prior authorization requires encryption to protect privacy?
* Mail
* Phone
* Fax.
* Email

Answer 1

Email

Question 2

Which statement is true?
* Reducing the determination time does not impact dispense rates.
* Reducing the determination time correlates with increased dispense rates.
* Increasing the determination time does not impact dispense rates.
* Increasing the determination time correlates with increased dispense rates.

Answer 2

Reducing the determination time correlates with increased dispense rates.

Question 3

What information can users see on the CoverMyMeds dashboard?
* All current and sent PA requests
* A menu of available insurance plans that use the service
* A list of all medications available to prescribe
* Full medical records for all the provider’s patients

Answer 3

All current and sent PA requests

Question 4

What percentage of prior authorization requests are completed by electronic prior authorizations (ePA)?
* Approximately 50%
* More than 90%
* Less than 10%
* Approximately 25%.

Answer 4

Approximately 50%

Question 5

Which factor could be a barrier, or slow down the process, of submitting a PA through a payer portal?
* Time of day it is available to use
* Patient health records are not electronic
* Amount of time it takes.
* Availability of prefilled forms

Answer 5

Patient health records are not electronic

Question 6

A patient needs a PA for a procedure, but the insurance guidance is unclear whether the procedure is medically necessary for this patient. There are a lot of questions that will need to be asked in order to make the determination. Which method of submitting a PA would be the most efficient to get all questions answered at the same time?
* Mail
* Email
* Phone
* Fax

Answer 6

Phone

Question 7

Why is it important to get a reference number and send a follow-up letter after telephone prior authorization?
* Reference numbers make it easier to follow up with the same person who made the authorization.
* Follow-up letters are good to keep for your records, so you remember the decision.
* Verbal authorizations may be difficult to prove and could be reversed.
* Reference numbers decrease the amount of time needed for the insurance company to decide.

Answer 7

verbal authorizations may be difficult to prove and could be reversed.

Question 8

TRUE/FALSE If computer systems are down on the provider or insurance side, responses may be delayed for ePAs.
* FALSE
* TRUE

Answer 8

True

Question 9

What function is not available for a provider to perform within a CoverMyMeds account?
* Complete a PA request that was started by a pharmacy.
* Renew a PA request
* Download or print a PA request
* Design a new PA request form

Answer 9

Design a new PA request form

Question 10

What does it mean if a PA request is returned as pending?
* The insurance company wants more information than provided; the PA will be reviewed when additional information is submitted
* The submitted information does not meet the criteria
* The insurance company wants more information than provided; the PA will go to peer-to-peer review and a decision will be made
* The submitted information meets the criteria

Answer 10

he insurance company wants more information than provided; the PA will be reviewed when additional information is submitted