Performance should include functions such as

Other categories

Insurance information

formulary
prescription drug benefits card
- patient ID number
- group number
- co-pay amount
referrals
prior authorization
primary care physician
search of insurance database for coverage
state, federal, and third-party insurance payer
communication of co-pay information to patient

Payment consideration

Prescription Essentials

Insurance types and providers

Exclusive Provider Organization (EPO), Preferred Provider Organization (PPO), Health Maintenance Organization (HMO), Health Savings Account (HSA), Point of Service Plan (POS), and Patient Centered Medical Home (PCMH)
workers’ compensation, Consolidated Omnibus Budget Reconciliation Act (COBRA), disability insurance, and manufacturer sponsored patient assistance programs
Hospice

Process/Skill Questions:

What are the steps in obtaining prior authorization? Why is each step important?
What is the role of a pharmacy technician in processing third-party payments and/or rejections?
What is the purpose of a financial audit?
What is the purpose of a third-party payer audit?
How would financial audits apply to the pharmacy setting? Why are they important?
What are the different types of insurance plans or cards in use?
How do the HIPAA privacy and security regulations affect billing processes involving third-party payers and vendors that process electronic payments (e.g., credit card companies, banks)?
How would billing proceed for a patient with more than one insurance plan?
What is the difference between primary and secondary insurance?