CVS CVS Assessment Insurance and Prescription Processing Questions and Answers

Question 1

What information is typically required to process a prescription through insurance at CVS?

Accepted Answer

BIN, PCN, group number, and member ID from the insurance card

Answer

Customer's email address and birth year only

Answer

The prescriber's office phone number and NPI

Answer

The customer's Social Security number and driver's license

Question 2

A claim is rejected with the message 'refill too soon.' This most commonly means:

Accepted Answer

The insurance will not pay because the previous fill has not run out yet based on days-supply calculations

Answer

The prescription has expired

Answer

The prescriber did not authorize refills

Answer

The drug is not covered under the patient's plan

Question 3

When a drug is rejected as 'non-formulary,' the best next step is to:

Accepted Answer

Notify the pharmacist, who may contact the prescriber about a formulary alternative or prior authorization

Answer

Tell the patient there is nothing that can be done

Answer

Bill the claim to a secondary insurance automatically

Answer

Substitute a different drug without prescriber knowledge

Question 4

What is a 'prior authorization' (PA) in the context of prescription insurance?

Accepted Answer

A process where the insurer requires medical justification before approving coverage for a drug

Answer

The patient's consent to fill the prescription

Answer

A prescriber's permission to dispense a controlled substance

Answer

CVS corporate approval to stock a high-cost medication

Question 5

If a patient wants to pay cash instead of using insurance for a prescription, what should the technician do?

Accepted Answer

Process it as a cash transaction at the applicable price and inform the patient of any discount programs

Answer

Refuse because CVS requires all prescriptions to be billed to insurance

Answer

Bill insurance first and apply cash as a secondary payment

Answer

Ask the patient why they are not using insurance before proceeding

Question 6

Days supply on a prescription is important to calculate accurately because it affects:

Accepted Answer

Insurance reimbursement, refill timing, and adherence monitoring

Answer

Only the pharmacist's verification step

Answer

The font size printed on the label

Answer

Whether a child-resistant cap is required