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WTI Insurance Ch. 6

Medical Insurance for Pharmacy Techs: Claim Preparation and Transmission

QuestionAnswer
True or False: Today most claims are filed using paper claims, although online claim submission is now being used sometimes. False
True or False: Recording the correct patient information is vital to a successful claim submission. True
True or False: Prescriber information must be verified in order for a prescription to be valid. True
True or False: The prescriber ID number may comprise five different identifiers. False
True or False: Patients will not have more than one insurance policy. False
True or False: If both parents cover dependents on their plans, the child’s primary insurance is usually determined by the birthday rule. True
True or False: If a patient is also covered as a dependent under another insurance policy, the patient’s plan is primary. True
True or False: Dispense as Written (DAW) codes are a set of National Drug Codes used to inform third parties of the reason why a brand or generic product was used to fill a prescription. False
True or False: The Average Wholesale Price (AWP) of a prescription drug is sometimes used to price pharmacy prescriptions in the retail setting. True
True or False: The maximum allowable cost is the lowest unit price that the payer or PBM will pay. False
What is the general beginning point for a successful claims transmission? Recording the correct patient information
Which component does not need to be recorded when completing the patient information portion of the claim? patient’s employer
What components are recorded when completing the prescriber information portion of a claim? prescriber ID (NPI or DEA), prescriber phone number, prescriber last name
All the pharmacy claim information is consistent for each prescription except for: name of the pharmacist who fills the order
The NPI was formerly known as the: NABP number
What components should be recorded when completing the insurance information portion of a claim: group ID, cardholder ID, patient relationship
The first insurance that a patient will use for claims is known as their: primary insurance
What components should be recorded when completing the prescription information portion of a claim: DEA number, drug name, drug dosage
What DAW code indicator whould be used when a patient wants to receive the brand product Nexium for their heartburn treatment instead of a similar generic drug? 2
What process must occur after the primary plan is billed, but before the secondary plan can be billed for any eligible unreimbursed amount? adjudication
Created by: lrhamyWTI