Pharmacy Pharmacy Billing and Insurance

Question 1

What does the DAW code '1' indicate on a prescription?

Accepted Answer

Dispense as written — brand medically necessary

Answer

Generic substitution allowed

Answer

Patient requested brand

Answer

No product selection indicated

Question 2

Which field on a pharmacy claim identifies the prescriber's DEA number?

Accepted Answer

Field 411-DB

Answer

Field 444-E9

Answer

Field 340-7H

Answer

Field 103-A3

Question 3

A patient's insurance plan has a $300 deductible that has not been met. The medication costs $120. What does the patient owe?

Accepted Answer

$120

Answer

$0

Answer

$300

Answer

$60

Question 4

What is a formulary in the context of pharmacy insurance?

Accepted Answer

A list of drugs covered by an insurance plan

Answer

A prescription routing system

Answer

A drug interaction database

Answer

A patient allergy record

Question 5

Which reject code indicates that a patient's prescription benefit has reached its plan limit?

Accepted Answer

76 — Plan limitations exceeded

Answer

70 — Product not covered

Answer

88 — DUR reject

Answer

41 — Submit bill to other processor

Question 6

A co-pay assistance card cannot be used with which type of plan?

Accepted Answer

Federal or state government insurance such as Medicare or Medicaid

Answer

Commercial PPO plans

Answer

Employer-sponsored HMO plans

Answer

High-deductible health plans