Pharmacy Pharmacy Billing and Insurance 2

Question 1

What does 'coordination of benefits' mean in pharmacy billing?

Accepted Answer

Determining which insurer pays first when a patient has multiple plans

Answer

Submitting a prior authorization request

Answer

Reconciling a pharmacy's end-of-day claims

Answer

Verifying a patient's eligibility for a plan

Question 2

Which National Drug Code (NDC) segment identifies the specific package size of a medication?

Accepted Answer

Package code (last 2 digits)

Answer

Labeler code (first 5 digits)

Answer

Product code (middle 4 digits)

Answer

Lot number

Question 3

A pharmacy submits a claim and receives an 'eligibility not found' rejection. What is the most likely first step?

Accepted Answer

Verify the patient's insurance ID, group number, and date of birth

Answer

Call the prescriber to reissue the prescription

Answer

Dispense the medication and bill the patient in full

Answer

Submit the claim to Medicaid instead

Question 4

What is the purpose of a prior authorization (PA) in pharmacy?

Accepted Answer

To obtain insurer approval before dispensing a non-formulary or restricted drug

Answer

To allow a patient to pick up a refill early

Answer

To transfer a prescription from another pharmacy

Answer

To override a refill-too-soon rejection

Question 5

Which claim field is used to report the prescriber's NPI number?

Accepted Answer

NCPDP field 411-DB (Prescriber ID)

Answer

NCPDP field 444-E9

Answer

NCPDP field 202-B2

Answer

NCPDP field 301-C1

Question 6

A drug is classified as Tier 3 on a formulary. What does this typically mean for the patient?

Accepted Answer

Higher co-pay, usually for non-preferred brand drugs

Answer

Lowest co-pay, generic drugs

Answer

Specialty drugs requiring special handling

Answer

Drug is not covered at all