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Chapter 13 Vocab

Adjudication Electronic insurance billing for medication payment
Average Wholesale Price (AWP) The average price at which a drug is sold
Closed Formulary Medication use is tightly restricted to the medications provided by the formulary list
Co-pay The portion of the prescription bill that the patient is responsible for paying
Drug Topic Red Book Reference book listing NDC numbers, manufactures, and AWP of drug products
Drug Utilization Evaluation/Review (DUE) (DUR) The process by which pharmacist ensure proper medication utilization
Formulary A list of preapproved medications that are covered under a prescription plan or within an institution
Health Insurance Portability and Accountability Act (HIPPA) Federal guidelines for the protection of a patients personal health data
Material Safety Data Sheet (MSDS) Information sheets supplied to the pharmacy from the manufacturer of chemical products and how to handle accidental exposure to them
Medicare Modernization Act (MMA) The enactment of prescription drugs covered for persons covered under Medicare and set limitations on how much they had to pay
National Drug Code (NDC) 10 digit number given to all drugs for identification purposes
National Provider Identifier (NPI) number assigned to any health care provider that is used for the purpose of standardizing health data transmissions
Open Formulary A formulary list that is essentially unrestricted in the types of drug choices offered or that can be prescribed and reimbursed under the health provider plan or pharmacy benefit plan
PAR Periodic automatic replacement of stock levels to a certain number of units allowed
Patient Profile A document listing the necessary patient personal and health information including comprehensive information on the medication they are taking
Pharmacy and Therapeutics Committee Medical staff composed of physicians and pharmacist who provide necessary information and advice to an institution or insurer if a medication should be added to the formulary
POS Point of Sale or Point of Service
Prior Authorization Insurance-required approval for a restricted, non-formulary, or non-covered medication before a prescription medication can be filled
Trade/Brand/proprietary name The name a company assigns for marketing and identification purposes to a commercial drug product
Treatment Authorization Request (TAR) similar to the preauthorization form but used for Medicare and Medicaid
HMO Health maintenance organization
Medicare Government-managed insurance program composed of several coverage plans for health care services and supplies funded by government and state; must be 65+, younger if have long-term disability's or suffering from end-stage renal disease
Medicaid Government-managed insurance program that supplements Medicare if the individual meets specific requirements; for low-income, the elderly, blind, and those with disability's
Medigap Plans Supplement insurance polices provided through private insurance programs to help cover the cost not reimbursable by Medicare plan such as co-pay, co-insurance, and deducible
PPO Preferred provider organization
Workers Compensation Government-required and government-enforced medical coverage for workers injured on the job paid for by the employers managed by each sate depending on their work compensation laws
Created by: must learn



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