Billing & Insurance – PTCB Pharmacy Technician Certification
Master the essential billing and insurance concepts tested on the PTCB exam with these 20 targeted flashcards. Topics include third-party payer processes, claim adjudication, coordination of benefits, and common billing errors. Ideal for pharmacy technician candidates seeking to strengthen their knowledge of prescription reimbursement and insurance workflows.
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Preview Questions
Question 1
What term describes any payer other than the patient who reimburses a pharmacy for prescription costs?
Answer
A third-party payer. This includes insurance companies, government programs (Medicare, Medicaid), and pharmacy benefit managers (PBMs).
Question 2
What is a Pharmacy Benefit Manager (PBM)?
Answer
A PBM is an intermediary company that manages prescription drug benefits on behalf of insurers, employers, or government programs, and negotiates drug pricing and formularies.
Question 3
Which federal program provides prescription drug coverage through Medicare Part D?
Answer
Medicare Part D is a voluntary federal program that provides outpatient prescription drug coverage to Medicare-eligible individuals through private insurance plans.
Question 4
What is a formulary in the context of pharmacy insurance?
Answer
A formulary is a list of prescription drugs covered by an insurance plan, often organized by tiers that determine the patient's co-pay amount.
Question 5
What is the standard electronic format used to submit pharmacy claims to insurance companies?
Answer
The NCPDP (National Council for Prescription Drug Programs) D.0 transaction standard is used to electronically transmit pharmacy claims to payers.
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