New Tech at Walgreens: I Need Help with Handling Insurance Problems...

by Joseph
(Florida)

Prescription Insurance Rejection Questions...

Prescription Insurance Rejection Questions...

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?

Answer:

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

how long the PA is good for, for example, for 6 months or 1 year. I usually make a note of this on the patient's profile if I have been given it. Sometimes the patient will find out from the doctors office. When this happens, the patient usually calls the pharmacy.

And a Page on Refill Too Soon Rejections:
Refill Too Soon.

DUR Rejects are different from the previously mentioned rejections. Sometimes, depending on the insurance company, entering override codes (Walgreens will have a copy of these or the pharmacist/other techs should know these) will get the insurance company to pay for a claim. Other times, a DUR Rejection means calling up the insurance company and they can enter the codes on their end or provide you with the codes to enter on your end. It is a good practice to stay on the phone with an insurance representative until you receive a paid claim on your end of things. Also, sometimes if you go to the insurance companies website, they might have the override codes listed there as well.

As far as “Filled After Coverage Terminated” rejections go, this usually means that the insured patient is no longer covered by that insurance company. The pharmacy I work at has subscribed to a website called Emdeon and we are able to look up a customers insurance (if they have coverage) there and enter it into our software and get the medication covered for them, sometimes without them even knowing there was a problem or even providing us with a new insurance card. Maybe Walgreens has a similar database that they can tap into in this situation.

I hope this information has helped answer your question. It is a great question and if you need any more help or have any other questions, feel free to ask them!

Comments for New Tech at Walgreens: I Need Help with Handling Insurance Problems...

Average Rating starstarstarstarstar

Click here to add your own comments

Rating
starstarstarstarstar
INSURANCE
by: Anonymous

Just wish to say your article is as amazing. The clarity in your post is simply spectacular and i can assume you are an expert on this subject. Fine with your permission let me to grab your feed to keep updated with forthcoming post. Thanks a million and please continue the gratifying work.



Rating
starstarstarstarstar
thanks
by: Joseph

thank you this has been very helpful!!!! and it has cleared a lot of things that i was confused with or didnt actually had a clue about.

Click here to add your own comments

Join in and write your own page! It's easy to do. How? Simply click here to return to Ask A Question....

Back to Home

[?]Subscribe To This Site
  • XML RSS
  • follow us in feedly
  • Add to My Yahoo!


Didn't find what you were looking for? Use the box below to search this entire site.

Custom Search



Recent Articles

  1. SILICONE RINGS IN A CLEAN ROOM

    Jan 13, 19 07:44 PM

    The USP797 rules state that no jewelry can be worn in the I.V. clean room setting because it wouldn't be sterile. I was wondering if silicone rings would

    Read More

  2. Did my pharmacist violate hips law today

    Jan 13, 19 05:34 PM

    While approaching my pharmacy counter today my pharmacist very loudly said Nicole I found out what was wrong with your suboxane P.A.Your Dr. Office done

    Read More

  3. When can it be refilled? 35 pills, 3 times a day, so it's not even.

    Jan 13, 19 04:50 PM

    35 pills, 3 times a day, so it’s not even. When do I refill?

    Read More

  4. Day Supply: Take 1 tab TID #100

    Jan 13, 19 04:26 PM

    Take 1 Tablet TID, dispense #100 Refills 2 What is the days supply for insurance?

    Read More

  5. IV vs. Oral Medication Pharmacology - Absorption or Metabolism

    Jan 13, 19 03:57 PM

    When a drug is given IV rather than orally, it eliminates the need for what? Absorption or Metabolism?

    Read More

  6. A question about Synthroid Vs. Sintrocid and drug milligrams?

    Jan 13, 19 03:37 PM

    What is the difference in 0.112mg in Synthroid and 100mcg in Sintrocid from Mexico? Would this be the same dosage?

    Read More

  7. Wondering About How Many Percocet Should be in my Bottle?

    Jan 13, 19 02:17 PM

    I had a prescription filled for my #120 Percocet on February 18th, how many of the pills should be in my bottle on March 16th? The directions are for me

    Read More

  8. How Does Nalexone Nasal Spray Help an Overdose Victim?

    Jan 01, 19 07:07 PM

    This page discusses, "How Does Nalexone Nasal Spray Help an Overdose Victim?"

    Read More

  9. Fioricet Script is for 60 pills take 2 every 8 hours How many days supply is that?

    Jan 01, 19 06:34 PM

    I have a script for Firocet. It says take 2 pills every 8 hours. It was written for 60 pills. How many days of supply is it?

    Read More

  10. Is it still a 20 day supply if “as needed” is written?

    Jan 01, 19 06:28 PM

    Percocet 5/325, qty: #60, take 1 tablet by mouth 3 times a day as needed for severe pain. Is this a 20 day supply, even though it says, “as needed?” Will

    Read More

  11. Suboxone film take 2 and 1/2 per day given quantity of 70.

    Jan 01, 19 06:16 PM

    How many days will #70 Suboxone Film last at a dose of 2 & 1/2 per day?

    Read More

  12. Diphenhydramine 25mg tablets Days Supply 2 tabs po qid #40

    Jan 01, 19 05:53 PM

    BENADRYL (diphenhydramine) 25MG TABLETS TAKE 2 TABLETS PO QID #40 NEED THE PRACTICE METHOD ON THIS BROKEN DOWN

    Read More

  13. Tresiba 200 units/ml insulin, 60 units sq qd: Days Supply and Quantity Questions

    Jan 01, 19 05:39 PM

    Tresiba 200units/ml 60 units sq qd How many individual pens will be used in 30 days and how many box(es) will be needed for a 30 day supply?

    Read More

  14. How to calculate days supply for testosterone injection, 10m, inject 0.75 'll on every 1st and 15th of the month

    Jan 01, 19 03:39 PM

    How to calculate days supply for testosterone injection, 10ml, inject 0.75 ml on every 1st and 15th of the month

    Read More

  15. Bromfenac(bromday) 0.09%

    Jan 01, 19 03:14 PM

    I am to instill 3 drops into both eyes 3 times a day. Received prescription, of 3 bottles/vials, on 16 Mar 8 and need to know how to figure how long

    Read More