CVS Assessment Insurance and Prescription Processing Questions and Answers Flashcards
6 cards from real CVS practice questions. Tap to flip, then mark Knew It or Still Learning — missed cards come back until you master them.
Read the first 6 CVS Assessment Insurance and Prescription Processing Questions and Answers flashcards as text
A Medicare Part D plan rejects a claim stating 'coverage gap.' This likely means the patient:
Answer: Has entered the Medicare donut hole phase of their benefit year where cost-sharing increases
The Medicare Part D coverage gap (donut hole) occurs after initial coverage limits are reached, requiring higher patient cost-sharing until catastrophic coverage begins.
A prescription written by a nurse practitioner is rejected by insurance because 'prescriber not eligible.' What does this rejection mean?
Answer: The nurse practitioner's NPI is not enrolled with or recognized by the patient's pharmacy benefit plan
Insurers require prescribers to be enrolled in their network; an unrecognized NPI triggers a 'prescriber not eligible' rejection.
What should a technician do if a patient's insurance requires a generic but the prescriber wrote 'dispense as written' (DAW)?
Answer: Inform the pharmacist, who will decide whether to dispense brand per prescriber direction and advise the patient of any extra cost
DAW codes determine substitution rights; the pharmacist must manage the clinical and financial implications with the patient.
When entering a new prescription into the CVS system, why is selecting the correct patient profile critically important?
Answer: It ensures the right patient's insurance, allergy, and drug history are linked to prevent errors and claim rejections
The patient profile ties together insurance, allergy alerts, and drug interaction checks—selecting the wrong profile can cause harm and billing errors.
A customer's co-pay for a medication is $45, but they only have $30. The best course of action is to:
Answer: Inform the patient of the balance due, mention any applicable CVS discount or assistance programs, and hold the prescription if they cannot pay
CVS policy requires collecting the co-pay; technicians should inform patients of assistance programs but cannot waive required cost-sharing.
Why is it important to verify a patient's date of birth when processing their prescription?
Answer: To confirm identity and ensure the prescription is matched to the correct patient profile, reducing dispensing errors
Date of birth is a standard identifier used to match the patient to the correct profile and prevent cross-patient dispensing errors.
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