Ch 3 Flashcards
(22 cards)
How do you confirm that you have the correct patient on file?
verify the full name, date of birth and address
What are some universal requirements for a new patient profile?
- the full name
- dob
- address and telephone
- medical history
- medication, prescription and allergy history
- prescription preferences
- HIPAA acknowledgement
What is a “drug-drug interaction”?
when there is a medication a patient is taking that interacts with the new medication being entered
What is a “therapeutic duplication” error?
when new medication is used to treat a condition for which the patient is already receiving another drug
When is an “unnecessary drug” error shown?
if the medication prescribed does not have an appropriate therapeutic indication for the patient or if the dosage prescribed seems excessive
What is a “non-formulary drug” alert?
indicates the prescribed medication does not appear on the formulary from the patient’s insurance plan
What is a list of medications covered by an insurance company called?
a formulary
What information is needed for an insurance claim?
- patient info
- prescriber info
- pharmacy info
- prescription info
What kind of patient info is needed for an insurance claim?
patient’s name, dob, address, phone number, relationship to the cardholder
What kind of prescriber information is needed for an insurance claim?
prescriber’s NPI or DEA, and contact info
What kind of pharmacy information is needed for an insurance claim?
pharmacy’s NPI, pharmacy’s name, pharmacy’s contact info
What kind of prescription information is needed for an insurance claim?
prescription number, NDC number, quantity dispensed, and day’s supply
What information is included on a prescription insurance card?
the ID number, the BIN number, the plan number, the group number, the issuer and the relationship code
What is a prescription insurance card BIN number?
the bank identification number, is used to help identify the company that will reimburse the pharmacy for the prescription
What is the plan number on a prescription insurance card?
the prescription provider code
What is the group number on a prescription insurance card?
the code from the emploter that contracted with the insurance company
What is the issuer on a prescription insurance card?
the insurance company
What are the relationship codes that are listed on an insurance card?
cardholder is 01, spouse is 02, dependent is 03
What are the three major types of insurance programs?
private health insurance, managed care programs, government plans
What are some examples of private health insurers?
Blue Cross Blue Shield, Health Maintinance Organizations, Kaiser Foundation Health Plan, and Worker’s Compensation
What are some examples of managed care programs?
Independent Practice Association, Preferred Provider Organization
What are some examples of government plans?
Medicare, Medicare Part A, Medicare Part B, Medicare Part C, Medicare Part D, Medicaid, TRICARE, and CHAMPVA
