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15 Cards in this Set
- Front
- Back
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Adjudication |
Electronic insurance billing for medication payment |
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Closed Formularly |
Under a closed formulary, only specific drugs in each drug class are covered. Formulary drugs include most generics and selected brand medications
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Average Wholesale Price |
The average price at which a drug is sold |
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Prior Authorization |
Insurance required approval for a restricted, non-formulary or non covered medication before a prescription medication can be filled |
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National provider Identifer |
Number assigned to any health careprovider that is used for the purpose of standardizing health data tranmissions |
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Drug utilization evaluation or review |
The process by which pharmacists ensure proper medication utilization |
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National Drug Code |
Ten digit number given to all drugs for identification purposes |
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Formulary |
A list of preapproved medications that are covered under a prescription plan or within an institution |
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Health insurance portability and accountability act |
Federal guidelines for the protection of a patients personal health information |
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Patient Profile |
A document listing necessary patient personal and health information including comprehensive information on the medications they are taking |
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Who is responsible for pharmacy inventory stock? |
Everyone |
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What is third party billing? And who would be considered third party? |
The portion of payment reimbursed by insurance companies.Patient, insurance company , and hospital are considered third party. |
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Name the four main areas that affect how much a patient pays for a prescription |
1.Share of cost 2. Penalty 3.Grace Period 4. Deductiblee |
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4 Reasons why insurance companies refill drugs early? |
1. Lost medication 2. Going on a vacation 3. Increase indose |
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Steps to insure a patient receives there medicine in a timely manner for workman's comp |
1. Ask for HR info 2. Call hr get info |
