Medical Insurance for Pharmacy Technicians

Chapter 1: From Prescription to Payment: Becoming a Pharmacy Technician Insurance Specialist

The Importance of Pharmacy Benefits

Medical Insurance Basics

The Pharmacy Practice Billing Cycle

Procedures, Communication, and Information Technology in the Pharmacy Billing Cycle

Effects of Pharmacy Claim Errors

Chapter 2: Medicolegal Issues and the Pharmacy

Health Care Regulation

Pharmacy Records

HIPAA Privacy Rule

HIPAA Security Rule

HIPAA Electronic Health Care Transactions and Code Sets

Other Legislation Affecting Pharmacy

Fraud and Abuse Regulations

Pharmacy Question and Answers

Chapter 3: Private Insurance Payers and Plans

Private Insurance

Types of Health Plans

Pharmacy Plan Benefits

Pharmacy Benefit Management Techniques

Calculating Charges

Chapter 4: Medicare

Medicare Overview

Medicare Part B Plans

Who Pays First?

Medicare Part D

Chapter 5: Medicaid, TRICARE, CHAMPVA, Workers’ Compensation, and Discount Card Programs

Medicaid

TRICARE and CHAMPVA

Workers’ Compensation

Discount Card Programs

Chapter 6: Claim Preparation and Transmission

Pricing Prescriptions

Creating Claims

Transmitting Claims

Coordination of Benefits

Chapter 7: Processing Claims and Appealing Decisions

Payer Adjudication of Claims

Collecting Patient Point-Of-Sale Payment

Pharmacy Processing of Payer Claim Payment

Balancing Transactions

Appealing and Resubmitting Claims

Insurer/PBM audits

Medical Insurance for Pharmacy Technicians provides a practical, focused overview of medical insurance and billing of prescriptions in the community pharmacy setting. Each chapter is structured to give students a hands-on, practical approach to understanding and working with prescription charges and the billing process. This text is precisely tailored for a brief introduction to the fundamental understanding of claim processing principles for pharmacy technicians.