Types of Insurance
Encourage patients financially to use doctors who have contracts with the plan. (IN-NETWORK)
Preferred Provider Organizations (PPOs)
An individual, including a physcian or a pharmacy which sells or rent Part B covered items to Medicare
DMEPOS Supplier
Are entitled companies that have created their own specialty pharmacies with organizations
PBMs and other insurance
The process of electronically submitting prescription claims to the approriate PBM for its judgement on whether or not it will provide reimbursement
Online Adjudication
This must keep former employees in its coverage plans to allow transition to their next jon without loss of health insurance
Consolidated Omnibus Budget Reconciliation Act (COBRA)
Special payment rules for items furnsihed by DMEPOS suppliers and rules regarding issuance of suppliers billing privileges
DMEPOS Supplier Standards
Treat complex & chronic conditions such as rheumatoid arthritis, HIV, rare genetic disorders and more
Specialty Pharmacy Durgs
10-digit identification number for covered health care providers usually used to locate a provider in the computer system and for billing purposes
NPI
For the children
Children's Health Insurance Programs (CHIPs)
Notifies the patient about any medicare decisions
ABN (Advanced Beneficiary Notice): Written notice from Medicare given to patients before receving certain items or services
Specialty Drugs may require what?
Prior authorization & close monitoring
Combination of letters and number of desginated a specific diagnosis for a patient
ICD-10 code
For the veterans, military, and military dependents
The Benefits Form, infroming the patient about their Medicare
AOB (Assignment of Benefits): agreement between the patient and doctors other health care suppliers or providers and Medicare
Scheduling home infusions for a patient
Working closely with insurance and prescriber's office to resolve prior authorizations
Requesting addtional supplies
Are Roles of what?
Tech Role in Specialty Pharmacy
Identifies which person within a family the ID # belongs to
Person Code
This insurance has 4 main parts; ABCD
Medicare
Insulin Syringes, Insulin pen needles are part of?
Part D
Usually injected or infused, but occasionally can be a pill can be found where?
Specialty Pharmacy Drugs
Used to identify the specific plan under the insurance
PCN