PTCE Billing and Reimbursement Flashcards
6 cards from real PTCE practice questions. Tap to flip, then mark Knew It or Still Learning — missed cards come back until you master them.
Read the first 6 PTCE Billing and Reimbursement flashcards as text
What does DAW stand for in pharmacy billing?
Answer: Dispense As Written
DAW (Dispense As Written) is a code indicating the prescriber requires the brand-name drug rather than a generic.
What is the primary purpose of a prior authorization (PA) in pharmacy billing?
Answer: To obtain insurance approval before dispensing a specific medication
A prior authorization requires the prescriber to obtain insurance approval before a non-formulary or specialty drug will be covered.
What is the BIN number on a pharmacy insurance card used for?
Answer: To route prescription claims to the correct insurance processor
The BIN (Bank Identification Number) is a 6-digit number used to route electronic prescription claims to the correct insurance processor.
What does a pharmacy formulary contain?
Answer: A list of drugs covered by an insurance plan
A formulary is an insurance plan's approved list of covered medications, often organized into tiers that affect the patient's copay.
What is coordination of benefits (COB) in pharmacy billing?
Answer: A process that determines payment order when a patient has two insurance plans
COB ensures that when a patient has primary and secondary insurance, both are billed correctly so total payment does not exceed the drug cost.
What does the PCN number on an insurance card identify?
Answer: Processor Control Number used to route claims
The PCN (Processor Control Number) works alongside the BIN to further direct claims to the correct benefit plan within an insurance processor.