Med D Pt. 2

1.

1 point

All Med D Benefits will have both a deductible and a MOOP

True

False

2.

1 point

On Straddle claims, the TROOP will be populated with...

$1 more than the “Dollar Amount/Threshold"

The “Dollar Amount/Threshold"

$1 less than the “Dollar Amount/Threshold"

None of the above. We do not test Straddle for Med D benefits.

3.

1 point

Work Manager IDs (WMID)...what are they good for?

Absolutely nothing!

Generating an input grid through the automation tool

Generating a compared output grid through the compare tool

Both B and C

4.

2 points

Who's got output issues? You do!
You are attempting to test Initial Coverage (ICL) copays, but something's not right. You scroll over to check out your Benefit Entry and Benefit Final columns to see if the claim jumped stages...Benefit Entry shows a "2" for this claim, but Benefit Final shows "3"...

Assuming your benefit has a deductible, what stage did we start and end in?

The claim started in IC, but ended in CAT

The claim started in IC, but ended in GAP

The claim started in DED, but ended in IC

Psh, nobody actually uses those columns.

5.

1 point

You're reviewing claims. Your Deductible Straddle claim shows the Benefit Entry as 1 and the Benefit Final as 2...what happened?

We do not run Straddle claims for Med D benefits.

Something caused our claim to jump stages, we need to review.

The claim moved from the Ded phase to ICL...we win!

The claim started in IC and ended in GAP

6.

2 points

Straddle claims should be added for which of the following Med D stages/accumulators? (Select all that apply)

GAP>CAT Stage

MOOP/OOP Accums

CAT>Infiniti and Beyond Stage

TROOP Stage

ICL>GAP Stage

Drug Spend Stage

DED>ICL Stage

7.

1 point

LICs Deductibles may occur on which LICs benefits?

Lics 1

Lics 2

Lics 3

Lics 4

Lics 5

All of the above

8.

1 point

It's still 2015. To test GAP, you need to add what amount to the TROOP_AMT, TROOP_DRUG_SPEND and TROOP_DED_DRUG_SPEND columns?

320

2960

2960 + 320 if there is a deductible

Trick question! We don't use all three columns.

9.

1 point

It's still 2015 and we're still trying to test GAP. We got our output back, and our claims are...not great. We preloaded 2960 to put us in the GAP stage, but the copay is all wrong. We notice that there is an ingredient cost on the claim of $9,950. What probably went wrong here?

There is a setup error

The cost of the drug would have no impact on the output. Stop trying to trick me.

We preloaded wrong.

The cost of the drug bumped us into the CAT stage

10.

1 point

There's no deductible on this benefit. As far as the Benefit Entry/Final columns are concerned, the Catastrophic Stage would be stage number...

0

1

2

3

4

11.

1 point

When testing MOOPs/DED, you will need to add claims for (select all that may apply):

Mail Order

Each Range

Retail

Each PP

Each Stage

12.

1 point

You just finished building your input grid, and it is beautiful. While doing your final review of the intent to make sure you have everything, you notice some Copay rules that appear to only apply to Walgreens pharmacies. You check your input grid again and you don't have any claims for them...What now?

Any intent not built by the Automation tool is out of scope of testing.

We will need to manually build the claims ourselves.

We do not test Pharmacy Specific rules.

It's probably a typo on the intent...lets just run the claims and call it a day.

13.

1 point

For MEDD Clinical SRs, what type of intent documents should you be on the lookout for in the Attachments tab?

HPMS Files, Custom Rule Request Forms, Form F's

Enrollment Form and BAC addendum

MEDD Copay Grid

CBA emails with attachments

Both A & D

14.

1 point

For Med D Clinical SRs, which scenarios require claims to be run?

Price Point/Tier Changes

Modifications of existing rule criteria

New Clinical Rules

MEX ID

Both A & B

15.

1 point

For MEDD Clinical SRs, which scenarios may allow for just validation?

Price Point/Tier Changes

Modifications of existing rule criteria

New Clinical Rules

MEX ID

Both A & B

16.

1 point

If you receive reject A5, what should you do?

Cry

Put in an override

Contact CBA

Find a new NDC. These cannot be overriden.

17.

1 point

A "D" in the compare code indicates what about the claim?

It is a GAP claim

The claim is testing a Deductible

Med D Eligible Claim

NonDeductible claim

18.

1 point

When filling in AAA/Legacy Accums, which of the following columns on the input grid will you need to fill in to successfully preload?

AAA DED/OOP Level Code

AAA DED/OOP Mail Amount (for Mail Claims)

AAA DED/OOP Retail Amount (for Retail Claims)

MBA Indicator

AAA DED/OOP Benefit Date