PTCE PTCE Billing and Reimbursement

Question 1

What does DAW stand for in pharmacy billing?

Accepted Answer

Dispense As Written

Answer

DAW (Dispense As Written) is a code indicating the prescriber requires the brand-name drug rather than a generic.

Question 2

What is the primary purpose of a prior authorization (PA) in pharmacy billing?

Accepted Answer

To obtain insurance approval before dispensing a specific medication

Answer

A prior authorization requires the prescriber to obtain insurance approval before a non-formulary or specialty drug will be covered.

Question 3

What is the BIN number on a pharmacy insurance card used for?

Accepted Answer

To route prescription claims to the correct insurance processor

Answer

The BIN (Bank Identification Number) is a 6-digit number used to route electronic prescription claims to the correct insurance processor.

Question 4

What does a pharmacy formulary contain?

Accepted Answer

A list of drugs covered by an insurance plan

Answer

A formulary is an insurance plan's approved list of covered medications, often organized into tiers that affect the patient's copay.

Question 5

What is coordination of benefits (COB) in pharmacy billing?

Accepted Answer

A process that determines payment order when a patient has two insurance plans

Answer

COB ensures that when a patient has primary and secondary insurance, both are billed correctly so total payment does not exceed the drug cost.

(PTCE) Pharmacy Technician Certification Exam Practice Test