CVS CVS Assessment Insurance and Prescription Processing Questions and Answers 2 — Questions and Answers
Question 1: A customer's insurance card shows two plans. Which is billed first?
- The plan with the higher deductible
- The primary insurance is billed first; the secondary insurance is billed for any remaining balance (Correct answer)
- Both plans are billed simultaneously
- The plan most recently issued always takes priority
Correct answer: The primary insurance is billed first; the secondary insurance is billed for any remaining balance
Coordination of benefits rules require the primary plan to be billed first; the secondary plan covers remaining eligible costs.
Question 2: A prescription is written for 'metoprolol 50 mg tabs, #90, 1 tab daily.' What is the correct days supply to enter?
- 30 days
- 60 days
- 90 days (Correct answer)
- 180 days
Correct answer: 90 days
90 tablets taken at 1 tablet per day equals exactly 90 days supply.
Question 3: What does the acronym 'BIN' stand for on a pharmacy insurance card?
- Beneficiary Identification Number
- Bank Identification Number (Correct answer)
- Billing Index Number
- Benefit Integration Node
Correct answer: Bank Identification Number
BIN stands for Bank Identification Number and routes the electronic claim to the correct pharmacy benefit manager (PBM).
Question 4: A patient is covered by Medicaid. Which special consideration applies at CVS?
- Medicaid patients must pay full cash price and seek reimbursement directly
- Medicaid has specific formularies and quantity limits that the system enforces; co-pays are often $0 or very low (Correct answer)
- Medicaid cannot be used at chain pharmacies, only independents
- Medicaid requires a separate paper claim form for every prescription
Correct answer: Medicaid has specific formularies and quantity limits that the system enforces; co-pays are often $0 or very low
State Medicaid programs impose strict formulary controls and often have $0 or minimal co-pays for eligible beneficiaries.
Question 5: When a prescription is transferred from another pharmacy, what information must be obtained?
- Only the drug name and quantity
- The complete original prescription information, dispensing history, and remaining refills from the transferring pharmacy (Correct answer)
- The patient's insurance card number only
- The original prescriber's personal fax number
Correct answer: The complete original prescription information, dispensing history, and remaining refills from the transferring pharmacy
Federal and state law require a full transfer record including original prescription details and remaining refills to be documented.
Question 6: What is the purpose of the 'PCN' number on a pharmacy benefit card?
- It identifies the patient's primary care doctor
- It is a secondary routing code that helps direct the claim within a PBM's system (Correct answer)
- It represents the patient's co-pay amount
- It is the patient's unique member identification number
Correct answer: It is a secondary routing code that helps direct the claim within a PBM's system
PCN (Processor Control Number) works with BIN to route the claim to the correct adjudication system within the PBM.
CVS CVS Assessment Insurance and Prescription Processing Questions and Answers 2
A customer's insurance card shows two plans.
Which is billed first?