Prescription Drug Insurance Flashcards
(32 cards)
Submitting a claim to a prescription drug insurance plan, requires what type of numbers from the patient’s card?
- bank identification number (BIN)
- processor control number (PCN)
- group number
- ID number
What institution has a 6-digit number identification of an accepted electronic pharmaceutical claim?
Bank identification number (BIN)
What set of numbers, letters, or combination of both where the supplement information is provided by the BIN called?
Processor control number (PCN)
What is an employer group that has a pharmacy plan called?
Group number
What is a patient’s single policy where their benefits and terms of coverage vary from each person within the same employer group called?
ID Number
What is the type of payment where patient pays full cost of the prescription without the help of any third party payers
Self-pay
What is an entity that is outside of the patient-pharmacist relationship that is involved in the financial transaction?
Third party payer
Who is the first party within the transaction of a third party payer?
Pharmacy
Who is the second party within the transaction of a third party payer?
Patient (or customer)
Who is the third party within the transaction of a third party player?
Insurance company (or other party)
What type of request is submitted to an insurance company for the payment of a product or service to the provider on the behalf of the patient, if the policy coverage of the product or service terms is specified?
Insurance claim
What is the cost of maintaining active insurance coverage called?
Insurance premium
What payment must a patient pay out-of-pocket (in addition to the premium) before the insurance benefits are realized called?
Deductible
What is the payment by the insured individual according to the terms of the insurance policy called?
Co-payment (or co-pay)
- insurance company pays the remaining expense
What type of managed care insurance plan is worked on by forming agreements with healthcare providers?
Health maintenance organization (HMO)
What type of managed care insurance plan covers medical expenses that are incurred from healthcare providers and hospital contracts?
Preferred provider organization (PPO)
What is a list of drugs that are covered under an insurance plan called?
Insurance formulary
What is a preferred drug list list that determines which medications will be maintained on-hand called?
Hospital formulary
What type of division of the United States Department of Health and Human Services (DHHS) is responsible for administrating government health insurance programs such as Medicare, Medicaid, and SCHIP (State Children’s Health Insurance Program)?
Centers for medicare and medicaid services (CMS)
What type of federally funded health insurance program covers the elderly (age 65 years and older) and people under age 65 with certain disabilities and certain types of kidney called?
Medicare
What are the four Medicare parts called?
1) medicare part A
2) medicare part B
3) medicare part C
4) medicare part D
Which Medicare part covers hospitalization insurance?
Medicare part A
Which Medicare part covers outpatient medical services, durable medical equipment (e.g. wheelchair), prevention services (e.g. immunizations), supplies needed to diagnose and treat medical conditions (e.g. blood glucose test strips and lancets for patients with diabetes), and certain medications that are not self-administered (e.g. oral cancer chemotherapy drugs and immunosuppressants)?
Medicare part B
Which Medicare part is optional and allows patients to obtain Medicare part A and B coverage through a private insurance company rather than through the federal government, and is also known as “Medicare Advantage Plans”?
Medicare part C
