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WTI Insurance Ch. 1

From Prescription to Payment: Becoming a Pharmacy Insurance Specialist

QuestionAnswer
Many health plans also cover preventive medical services, such as: prenatal care, pediatric and adolescent immunizations, and annual physical examinations
Workers’ compensation cases vary according to: state law
A physician would be likely to submit a prescription to a pharmacy by what methods? faxing the prescription, calling in the prescription, or electronically submitting the prescription
A remittance advice is also known as a(n): explanation of benefits
The final step in the pharmacy billing cycle is: collections and problem resolution
A pharmacy claim identifies all of the following except: the patient’s symptoms
The balance due on a claim is likely to be paid about how many days after the date of service? 30-60 days
Consultation by the pharmacist is offered on the proper administration of the drug during which step of the pharmacy billing cycle? point-of-sale patient payment
An electronic data interchange may be sent during which step of the pharmacy billing cycle? pharmacy claim transmittal
The payer starts internal processing of the claim for payment to the pharmacy during which step of the pharmacy billing cycle? Calculation of payer claim balance
True or False: Pharmacy technician insurance specialists may work in a large pharmacy practice where individuals specialize in various tasks or a small practice where individuals handle specific roles. True
True or False: Nationwide expenditures on outpatient prescription medications is expected to continue to decrease. False
True or False: First-dollar-coverage begins with the first charge of the year. True
True or False: To be classified as medically necessary, procedures must be approved by the appropriate federal regulatory agency. True
True or False: Policies that have a pharmacy benefit do not provide coverage for a selection of prescription medications. False
True or False: If a policyholder or a covered dependent gets sick, the health plan pays most of the bill. True
True or False: Dental care is almost always included in medical insurance policies. False
True or False: Most people enrolled in private insurance are covered under group contracts. True
True or False: Low-income people who cannot afford medical care are covered by TRICARE. False
Created by: lrhamyWTI