PHR 15: Week 5 Review

What is the appropriate action for a pharmacy technician when they receive a DUR alert?

• Consult the pharmacist

• Ignore the alert and proceed with the task.

• Ask another technician to review the alert.

• Dismiss the alert immediately.

Which of the following could lead to an insurance claim being denied? (Select all that apply)

• Claim exceeds policy limits

• Medication is covered by policy

• Incorrect claim details provided

• Policy has lapsed

Which of the following codes means that the physician has authorized a generic substitution?

• DAW 0

• DAW 1

• DAW 2

• DAW 3

The processing of claims by insurance companies over a computerized system is called:

The term third-party billing refers to the portion of payment:

• Reimbursed by insurance companies

• Managed by the primary parties involved in a transaction
• Processed by a government agency
• Related to the second-party billing

When submitting a claim to an insurance company, what additional information is required beyond what is found on a standard pharmacy label?

• Patient's dietary preferences

• Pharmacy's holiday schedule

• Local traffic conditions

• Specific insurance details such as policy number, group number, and insurance company contact information

Under what conditions do most insurance companies approve early prescription refills?

• When the patient experiences mild side effects from the current medication

• If the patient needs to switch to a different dosage of the medication

• If the medication is lost or stolen medication, or when the patient is traveling and needs extra medication

• When the patient wants to have extra medication on hand

Which of the following medications is most likely to require a prior authorization for insurance coverage?

• Ibuprofen

• Botox

• Amoxicillin

• Simvastatin

Which term describes the fixed amount a patient pays for a covered healthcare service, usually when receiving the service?

• deductible

• premium

• co-payment

• coinsurance

Which of the following are examples of plan restrictions?

• Days supply, refill limits, and step therapy.

• No restrictions

• High premiums

• Comprehensive benefits