INSURANCE 1
DOB and/or gender does not match
Invalid Person Code
number of days a dispensed quantity of medication will last
days supply
request for reimbursement from health care provider to insurance provider for products or services rendered
claim
covers prescriptions
Medicare part D
covers medical visits
Medicare Part B
maintains national formulary of prescription medications; may recall prescription and OTC products
FDA
someone could die
Class I Recall
products are in sufficient quantity to meet the demands of purchasers while controlling inventory size to generate optimal profits
Inventory Control
outside company can handle all processes of a return
Guaranteed Returns
incorrect duration of therapy
Insurance plan coverage limitation
set amount a client pays up front before insurance coverage applies
deductible
ID number that is unique to the primary insurance holder on the plan
member identification number
covers hospitalization
Medicare Part A
patients can choose in-network or out of network providers
PPO
limited listing of drugs and only covers listed drugs
Closed formulary
could cause harm, but not deadly
Class 2 Recall
number of times a product is purchased, sold, and replaced during a specific amount of time.
turnover rate
products that are less commonly needed
atypical products
physician has to get approval from insurance for medication
prior authorization
the patient's insurance company
CARRIER / INSURER / PROVIDER
identifies each household member under one plan that is receiving benefits and prescriptions
person code
must have a PCP that makes referrals
HMO (Health Maintenance Organization)
for people ages 65 and older, people with disabilities, and/or end-stage renal disease
Mediare
allows the pharmacy to obtain all medications that are prescribed and even covers meds that are not listed on the formulary
Open formulary
drug has been mislabeled or is noncompliant with regulations
Class III Recall
minimum and maximum stock levels used to determine when to reorder a drug
Reorder points (PAR levels)
hormone-like proteins produced by white blood cells to assist in the immune system
interferon
online processing of a prescription to the proper insurance company
adjudication
6 digit number assigned to a 3rd party processor for electronic routing of all transactions
BIN (bank identification number)
form of insurance for employees who are injured while at work
Worker's Compensation
drug manufacturers give discounts to hospitals, which place their drugs on hospital formularies; helps to reduce costs
340 B Program
a particular list of prescription drugs that is associated with certain amounts a patient will pay or co-pay (generic, preferred brand, and nonpreferred)
Tier
identifies meds for a drug recall
NDC and Lot numbers
most common method for delivery of medication orders
courier
not approved by the FDA, and are still in stages of testing; can be obtained through a clinical trial or through an outlet outside of clinical trials
investigational drugs
portion of the price of the medication that the patient is required to pay
Co-Pay
tells what plan a member falls under (usually the employer)
Rx group number
health insurance program for people and families with low incomes or with disabilities
Medicaid
tells which plan is billed as the primary and then how the other benefits will pay
Coordination of benefits
durable medical equipment
DME
usually received by phone, e-mail, or confirmation report
supplier's receipt
offer patient assistance programs with drug discounts or coupons
Drug manufacturers
secondary identifier used in routing pharmacy claims, and is assigned by the pharmacy benefits manager
PCN (processor control number)
How often do you check for expiration dates
monthly