Chapter 006 Study Guide

Question 1

If both parents cover dependents on their plans, the childs primary insurance is usually determined by the birthday rule

Accepted Answer

True

Question 2

Today most claims are filed using paper claims, although online claims submission is now being used sometimes

Accepted Answer

False

Question 3

The procedure of creating combination of drugs that are prepared or mixed prior to purchase is called:

Accepted Answer

Compounding

Question 4

Examples of DUR include all of the following except:

Accepted Answer

Drug cost analysis

Question 5

Most payers require the NCPDP universal claim form (UCF) for paper claims.

Accepted Answer

True

Question 6

The process by which prescribed meds are evaluated against explicit criteria to improve the quality of therapy

Accepted Answer

Drug Utilization Review

Question 7

In addition to verifying eligibility and adjudicating the claim, real-time systems perform which the following?

Accepted Answer

All of these

Question 8

The U&C price is the lowest price a provider can change the general public for specified drug.

Accepted Answer

False

Question 9

Within DUR, what type of precaution targets patients within a predefined age range to detect drugs?

Accepted Answer

Geriatric precaution

Question 10

The fee for a pharmacy’s professional services is known as the

Accepted Answer

Dispensing fee

Question 11

All of the following components should be recorded when completing the prescriber info portion of the claim except:

Accepted Answer

Pharmacy ID

Question 12

The first insurance that a patient will use for claims is known as their:

Accepted Answer

Primary insurance

Question 13

Patients will not have more than one insurance policy.

Accepted Answer

False

Question 14

What it DAW code indicator should be used when the patients wants to receive the brand product?

Accepted Answer

2

Question 15

Recording the correct patient info is vital to a successful claim submission

Accepted Answer

True

Question 16

All of the components should be recorded when completing the Rx info portion of a claim except:

Accepted Answer

NPI number

Question 17

What process must occurs after the primary plan is billed, but before the secondary plan can be billed?

Accepted Answer

Adjudication

Question 18

The pricing info for the AWP is based on data obtained from:

Accepted Answer

All of these

Question 19

Compounding may require a pharmacist to utilize meds knowledge and expertise to:

Accepted Answer

All of these

Question 20

Prescriber info must be verified in order for a Rx to be valid

Accepted Answer

True

Question 21

Which of the following components does not need to be recorded when completing the patient info portion of the claim?

Accepted Answer

The patients employer

Question 22

What components are recorded when completing the prescriber info portion of a claim?

Accepted Answer

All of these

Question 23

Where are claims routed in some cases before they are sent to the payer?

Accepted Answer

Switch vendors

Question 24

Within the pharmacy system, which of these three claim submission options are not used?

Accepted Answer

Phone

Question 25

The maximum allowable cost is the lowest unit price that the payer or PBM will pay.

Accepted Answer

False

Question 26

When a Rx Is field, the pharmacy may enter the Rx data into the internal system through all the following except:

Accepted Answer

A remittance advice

Question 27

In a pharmacy claim, the DAW code indicates whether the prescribers instruction regarding the generic were followed

Accepted Answer

True

Question 28

The patient fills out the first section of the UCF

Accepted Answer

False

Question 29

The AWP of a Rx drug is sometimes used to price pharmacy prescriptions in the retail setting.

Accepted Answer

True

Question 30

Prescribers ID consists of how many identifiers?

Accepted Answer

2

Question 31

The current average dispensing fee charged by state Medicaid programs is:

Accepted Answer

$12.70

Question 32

The greatest unit price that the player or PBM will pay for a drug is known as the:

Accepted Answer

Maximum allowable cost

Question 33

What is the general beginning point for a successful claims transmission?

Accepted Answer

Recording the correct patient information

Question 34

DAW codes are a set of NDCs used to inform 3rd parties for the reason why a brand/generic product was used to fill a Rx

Accepted Answer

False

Question 35

If paper claims are submitted, most payers require the NCPDP:

Accepted Answer

Universal claim form

Question 36

What does a patient need to do with a UCF?

Accepted Answer

Both A and B

Question 37

All outpatient prescription drugs or build using the NDC

Accepted Answer

True

Question 38

The NPI was formerly known as the:

Accepted Answer

NABP number

Question 39

What drug info is recorded on a claim using the drugs 11 digit NDC?

Accepted Answer

All of these

Question 40

For what type of person might the birthday rule apply in deterring someone’s primary insurance?

Accepted Answer

A child with 2 parents

Question 41

Once a claim has been submitted, whether electronically or on paper, it is subjected to editing for DUR

Accepted Answer

True

Question 42

Pharmacist are sometimes required to create meds and combination specific to individual patients

Accepted Answer

True

Question 43

All the pharmacy claim info is consistent for each prescription except for:

Accepted Answer

The name of the pharmacist who fills the order

Question 44

It is not necessary to indicate the DEA number on the prescription info portion of a claim

Accepted Answer

False

Question 45

The prescribers ID number may comprise of 5 different identifiers.

Accepted Answer

False

Question 46

Which of the following methods is not used to price pharmacy prescriptions in the retail setting?

Accepted Answer

Average allowable cost

Question 47

What pricing nothing is generally use as a drug pricing benchmark by payers?

Accepted Answer

The AWP

Chapter 006 Study Guide

Questions 47

Chapter 006 Study Guide

Questions 47