Intake and Patient Onboarding Flashcards
7 cards from real CSP practice questions. Tap to flip, then mark Knew It or Still Learning — missed cards come back until you master them.
Read the first 7 Intake and Patient Onboarding flashcards as text
A prior authorization appeal has been denied at the internal level. What option may the patient pursue next?
Answer: An external review by an independent review organization
Under the ACA, patients in most plans can request an independent external review after exhausting internal appeals.
Which situation would most appropriately qualify for an expedited (urgent) prior authorization review?
Answer: A delay could seriously jeopardize the patient's life or health
Expedited reviews are reserved for cases in which standard timeframes could seriously jeopardize the patient's life, health, or function.
What is a manufacturer 'hub' service primarily designed to do during patient onboarding?
Answer: Coordinate benefits verification, PA support, financial assistance, and pharmacy triage
Hub services centralize access support such as benefits investigation, PA assistance, and copay or PAP enrollment.
A new patient on a specialty drug has limited English proficiency. What is the most appropriate onboarding approach?
Answer: Use a qualified medical interpreter and provide translated materials
Federal civil rights guidance requires meaningful language access, best provided through qualified interpreters and translated materials.
Which tool would a specialty pharmacy use at onboarding to identify patients at risk for nonadherence?
Answer: A standardized adherence risk assessment or validated questionnaire
Baseline risk assessments (e.g., barriers like cost, health literacy, side effects) allow targeted adherence interventions.
A specialty pharmacy receives a referral for a hepatitis C regimen. Which baseline information is most often required for payer prior authorization?
Answer: HCV genotype, viral load, and liver fibrosis staging
Payers commonly require HCV RNA, genotype, and fibrosis assessment to approve direct-acting antiviral therapy.
When a patient's specialty drug requires refrigeration, what should be confirmed during onboarding?
Answer: The patient has appropriate refrigerator storage and understands temperature requirements
Confirming proper storage and educating on temperature requirements protects drug integrity after delivery.