Table Of ContentChapter 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
SynopsisMedical 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.