FastTrax Guide Claims Detail Claim Detail Manual Call Category/Call Type Complaints and Grievances
100
What is All Member Search
This allows internal users to search across clients for client
100
What is Dispensing Unit
What is NCPDP standard product billing codes Values: Each; Grams; Milliliters?
100
What is IVR
This tab has all call issues where the caller followed and entered the interactive voice response options.
100
What is Patient Inquiry
What Call Category would you use for A member is calling because our records indicate her eligibility is expired?
100
What is Guided Workflow
Where do you find the Complaint drop down?
200
What is Duplicate Issue
A new issue can be created based on the last issue by clicking?
200
What is Claim Type
This indicates the type of claim transmitted Example: Pharmacy or Member
200
What is Pharmacy Demographics
Where would you find
1. Pharmacy ID
2. Pharmacy Address
3. Dispenser Type
4. Other Pharmacy Data
200
What is Claim Inquiry/Data Entry
What Call Category will you use to reverse a claim for the pharmacy?
200
What is Inquiry
If the incoming case does not include an expression of dissatisfaction and is from an individual seeking information the case will be categorized as an ?
300
What is Fax Query tab
What tab is used to search, track, and work faxes received by the fax server?
300
What is Ingredient Count
This indicates the total number of ingredients included in the compound drug?
300
What is Clinical Tab
Where would you find
1. Submitted DUE/Professional Service
2. DUE/Professional Service Response
3. DUE Conflict
4. Patient Clinical
300
What is Drug Inquiry
What Call Category will you use if a member calls to confirm if a drug is on the formulary?
300
What is HIPPA
What is the acronym for Health Insurance Portability and Accountability Act?
400
What is New Issue Tab
This allows you to create a new call issue
400
What is Rx Origin
This indicates how original prescription was received by pharmacy
Example: Written, Telephone, Fax, etc.
400
What is Service Date
Indicates the date medication is being dispensed to the patient.
400
What is Reject Inquiry
What Call Type will you use if a pharmacy calls about a rejected claim?
400
What is FWA
What is the acronym for Fraud, Waste, and Abuse?
500
What is Brand Class Indicator Tab
What tab would you find the drug Manufacturer?
500
What is Submission Clarification Code
What code Indicates that the pharmacist is clarifying the override?
500
What is Adjudication Date
What is the date the claim processed through Magellan Rx Management POS system is called?
500
What is Complaint
What Call Category will you when a Beneficiary is expressing dissatisfaction relative to the Medi-Cal pharmacy benefit?
500
What is Appeal
If the incoming case is from someone disagreeing with and seeking reversal of the decision of a PA, it will be referred as an?






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