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Module 9

Section 3: Dispensing third-party prescriptions and submitting claims

QuestionAnswer
How can a pharmacy technician reduce the number of rejected claims or delayed claims payments? Check patient eligibility Collect copayments Track deductibles Determine coverage limitations
The process that describes how patient eligibility is verified through the pharmacy computer. Online adjudication
What are the patient details on a typical pharmacy benefit identification (ID) card? the patient's name The ID number the plan assigns to the patient The patient's date of birth The patient's copay amounts A list of dependents also covered by the plan
Under the Patient Protection and Affordable Care Act of 2010, children may be covered under their parents' insurance plans until what age? Twenty-six
What is a common claims submission error that can result in incorrect reimbursement rates or audits? Entering an incorrect National Drug Code number
When prescription claims are received by pharmacy benefit managers, why are they screened? To make sure that they are complete, accurate, and consistent with contract requirements
What feature of pharmacy computer systems enables the pharmacy technician to verify patient eligibility, determine whether a medication is covered, ad submit claims at the time the prescription is dispensed? Linking of pharmacy benefit manager computer systems to pharmacy point-of-sale systems
What rejection message would be prompted by a claim for a brand-name medication for which a generic alternative exists? Prior authorization from the pharmacy benefit manager is required
What information is requested by the pharmacy benefit manager (PBM) when prior authorization for a prescription is required? Documentation form the provider outlining the medical necessity for a medication that is not covered on the PBM's formulary
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