CPhT Insurance and Billing Flashcards
6 cards from real CPHT practice questions. Tap to flip, then mark Knew It or Still Learning — missed cards come back until you master them.
Read the first 6 CPhT Insurance and Billing flashcards as text
What does 'COB' stand for in pharmacy billing?
Answer: Coordination of Benefits
COB (Coordination of Benefits) is the process of determining which insurance plan pays first when a patient has multiple insurance plans.
What is a rejected claim in pharmacy billing?
Answer: An insurance claim that was not paid due to errors or eligibility issues
A rejected claim occurs when an insurance company does not process a prescription claim, often due to eligibility issues, incorrect information, or coverage limitations.
What is the difference between a deductible and a copay?
Answer: A deductible is a set amount paid before insurance kicks in; a copay is a fixed per-prescription fee
A deductible is the annual amount a patient must pay before insurance begins covering costs, while a copay is a fixed fee paid for each prescription.
What is a step therapy requirement?
Answer: A requirement to try lower-cost medications before a more expensive one is covered
Step therapy requires patients to try and fail on a preferred (usually cheaper) medication before insurance will cover a more expensive alternative.
What does 'NPI' stand for in pharmacy billing?
Answer: National Provider Identifier
NPI (National Provider Identifier) is a unique 10-digit identification number required for all healthcare providers, including pharmacies, for billing purposes.
When a pharmacy submits a claim using NCPDP standards, what type of claim is this?
Answer: An electronic pharmacy claim
NCPDP (National Council for Prescription Drug Programs) standards govern the electronic submission of pharmacy claims to insurance payers.