P
Durable medical equipment may be reimbursable to the pharmacy under Medicare part:
B
The primary routing mechanism for a real-time third party prescription claim is a:
person code
BIN
group number
member number
BIN
If a patient has two insurance plans, and the primary insurance carrier pays 75% of the charges, what is the most that the secondary will pay?
100% - 75%= 25% remaining
Most outpatient IV therapies require a _______.
An individual contract for health insurance ________.
preauthorization
is also called personal insurance
If a patient has both Medicare and Medicaid, charges must be filed with _______.
Medicare first and then Medicaid
A husband and wife both have insurance through their employers for themselves and each other. The insurance that should be considered primary for each of them is the one that:
insurance in their own name (cardholder)
TRICARE provides coverage for:
dependents of active and retired military personnel
A pharmacy tech is asked to COB a claim what does COB mean? Coordination of benefits is used when patient has ___
Coordination of benefits
primary and secondary insurance
Which of the following are examples of private insurance plans?
Medicare and Medicaid
HMO and EPO
Champva and IHS
EMS and HCFA
HMO and EPO
When submitting a claim for a new patient, the response is patient not found, which of the following is most likely the cause?
Prescription was just filled at another pharmacy
Prescription is non formulary
The pharmacy is not contracted with the insurance company
Patient information submitted does not match the patient information on file with the insurance company
Patient information submitted does not match the patient information on file with the insurance company
When a patient is required to go to a network healthcare provider, the patient is insured through:
a health maintenance organization (HMO)
You receive a rejected claim stating "refill too early." Which of the following could be the potential reason for the rejected claim?
Patient does not have current coverage
Wrong quantity ordered
Wrong days' supply
Wrong patient code
Wrong days' supply
Which of the following parts of Medicare covers drug prescriptions?
A B C D
Medicare Part D
Examples of plan limitations include:
Days' supply
Refill limits
Step therapy
What term refers to the portion of the prescription bill that the patient is responsible for paying?
copayment
Which of the following medications may require a prior authorization before adjudicating the prescription claim?
Amoxicillin/clavulanate
Botox
Conjugated estrogens
Furosemide
Botox
In which of the following circumstances do most insurance companies allow early refills?
Extended vacation
Disaster situation
Needing a backup supply
Extended vacation
Disaster situation
The information needed by insurance companies to process a claim from the pharmacy or to reimburse the patient is the same as the information required on a pharmacy label, plus:
Patient's date of birth
Insurance group number
Insurance identification number
The term third-party billing refers to the portion of payment:
The processing of claims by insurance companies over a computerized system is called:
Reimbursed by insurance companies
Adjudication
Which of the following codes means that the physician has authorized a generic substitution? DAW 0, 1, 2, 3
DAW 0
A reason(s) for the insurance company to reject a claim? 5 common reasons
coverage has expired
coverage limits have been exceeded
the patient is trying to refill a prescription too early
the cardholder’s information does not match the processor’s information
the prescribing physician is not the patient’s primary care physician (PCP).
A pharmacy technician receives a DUE alert; what should they do?
Contact the pharmacist
A patient who is allergic to penicillin has a chance of cross sensitivity to which of the following medications?
Cephalexin
Moxifloxacin
Doxycycline
Azithromycin
Cephalexin
Nicotine and nitroglycerin patches are examples of which of the following methods of drug administration?
Subcutaneous
Transdermal
Intramuscular
Intracapillary
Transdermal
Special IV tubing is recommended for the administration of:
nitroglycerin
ciprofloxacin
gentamicin
penicillin
nitroglycerin