Optum MedRx Yes or No

Yes or No

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About this activity

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

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Tiffany

United States

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Optum MedRx Yes or No


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

Optum MedRx Yes or No

Yes or No

About this activity

Created by

Download the paper version to play

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Optum MedRx Yes or NoOnline version

by Tiffany

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

The Date of Service and the Transaction date must match.

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

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

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?

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.

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

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

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

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

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

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

Is a Pharmacy required to have a Clearinghouse?

Are MedRx claims adjudicated in real-time?

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

Is Optum a Clearinghouse for MedRx services?

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

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

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

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

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

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

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?

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

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