Let’s Get Down to Business in the Pharmacy

Pharmacy TechnicianNo Comments

It’s important to keep in mind that the pharmacy not only provides the services of filling customer’s prescriptions but it is also a place of business. Over the next few weeks we’ll talk about some important business functions of the pharmacy. Today we will look at dealing with insurance companies.

Insurance Guru
Dealing with insurance companies can sometimes be a difficult process. When a prescription is rejected, the pharmacy technician may need to spend extra time figuring out why the patient’s insurance company is not covering the prescription. Be willing to spend this extra time trying to help the patient. Being empathetic to the patient’s frustrations with their insurance company will go a long way in improving how they view the pharmacy and determining if they will be a return customer.

The most common rejections you will encounter are:

  • NDC not covered
  • Patient not covered
  • Refill too soon

Most insurance issues will be resolved by making a phone call to the insurance carrier. In fact, a great deal of your time will be spent on the phone resolving third-party issues. This can be frustrating to the patient, so try and remain calm and empathetic if they become frustrated with the situation. It is not directed at you personally; they are angry with the process itself.

When dealing with insurance and especially potential errors in claims processing, there are a few terms and definitions used in the pharmacy that you need to be familiar with…

ID Numbers
If a claim is not processing, take another look at the ID numbers. Many plans may use letters preceding the ID number, such as XYZ1199A2883. Some insurance plans require the letters, but some do not. To make matters more complicated, the group number on the prescription card may be missing or incorrect. Some plans do not even require a group number.

Refill Too Soon
The notation “Refill Too Soon” may be one reason that a claim cannot be processed. Most insurance plans allow refills to be processed if the request is within seven days of the patient’s running out of a medication, but some plans are more restrictive.

Supply Limit Errors
Insurance companies have supply limits for certain drugs. A patient may have a prescription for a 90-day supply of Lipitor, but their insurance may only cover a 30-day supply. In this case, the pharmacy technician would get a rejection error indicating that only a 30-day supply is covered. The pharmacy technician will then need to resubmit the claim for a 30-day supply and notify the patient.

It may seem overwhelming at first when learning all about insurance companies and the issues that come with them, but before long, and with a little experience, you too will become an insurance guru.


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