I just started working at Walgreens and I don't know what half of the insurance problems are like what steps am I suppose to take in order to resolve them, like for example a prior authorization or a refill too soon or when to contact an agency?
This is a very good question. A good part of how to resolve these issues is probably in your handbook or in material that Walgreens employees may have given you when you started. As I have never worked for a Walgreens, I am not sure how they do things. However, I did just answer a question about Walgreen's Intercom Plus Software and you can read about it here: Pointers/Tips on Intercom Plus.
A few of the most common insurance rejections you will encounter include: Prior Authorizations, Refill Too Soons, DUR (or Drug Utilization Review) rejections, and Filled After Coverage Terminated rejections.
First, it would be a good idea for you to read about Prescription Insurance:
Prescription Insurance Basics.
I have a page on this site on Prior Auths:
Prior Authorization Basics.
Resolving Prior Auths involves:
1.) Notifying the patient. At this point, the patient is given the choice of paying out of pocket for the prescription (some people actually do do this) or waiting for the PA to be approved. At this point, if they decide to wait, the prescription usually goes “on file” (or “on hold”) and is not filled.
2.) Calling or faxing the prescriber’s office and notifying them so they in turn can call/fax the insurance company and provide them with the clinical information they need.
3.) Running the prescription again at the patient’s or prescriber’s request. Sometimes prescriber's offices will notify the pharmacy once they hear from the insurance company that the PA has been approved. Often when they are notified, they are also told
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