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. Prior Authorization Rejection

    Apr 10, 18 11:13 PM

    This page covers what a Prior Authorization is and why it happens.

    Read More

  2. My 10 yr olds prescription -- Is The Following Situation a HIPPA Violation?

    Apr 10, 18 10:00 PM

    I know someone who is a pharmacy tech. My 10yr.olds medication was called into the pharmacy she works at. Her daughter and my daughters have an on-off

    Read More

  3. My Pharmacy told my mom that I didn't pick up my meds. Is this a Hippa Violation?

    Apr 10, 18 09:26 PM

    My pharmacy told my mom I didn't pick up my meds. Yes, I do have same last name but I have a different address; for all they know, that wasn't my mom.

    Read More

  4. Vitamin Resources

    Apr 08, 18 02:43 PM

    Vitamin Resources - Information about Vitamin A, The B Vitamins, Vitamin C, and Vitamin D.

    Read More

  5. Two HIPPA Questions: Including, Can Pharmacy Techs counsel patients?

    Mar 27, 18 10:20 PM

    under the hippa law can a pharmacist and a pharmacy tech speak about a clients medical record amongs each other and cam pharmacy techs counsel the patient

    Read More

  6. Should pharmacy errors be reported anywhere?

    Mar 27, 18 10:11 PM

    Our pharmacy manager wants us to report any pharmacy error that happens. Why is it important to report errors? Where should we report the errors to?

    Read More

  7. Former employee working for competitor; Enticing former customers to new pharmacy

    Mar 27, 18 09:32 PM

    We had a pharmacy tech resign, then go to work at a grocery/pharmacy - the tech has used PHI to target our patients and entice them to transfer their prescriptions.

    Read More

  8. Wondering how many Percocet I should have left in my bottle?

    Mar 27, 18 08:57 PM

    I got my 120 Percocet Feb 18 how many should be in my bottle March 16 i take 4 a day

    Read More

  9. If my pharmacist states the name of my medication very loudly at pickup, is that a Hippa violation?

    Mar 27, 18 08:32 PM

    Is it a HIPAA violation if a pharmacist says what you are taking very loud so others can hear what you are taking?

    Read More

  10. Is Publicly mentioning the name of the drug the patient is on a HIPPA violation?

    Mar 20, 18 08:53 PM

    If the name of the drug is mentioned in order to further assist the patient with getting them the medication, is this a violation of hipaa?

    Read More

  11. Osmolarity/Hospital Potassium Infusion problem (3 Part Question)

    Mar 20, 18 08:43 PM

    At 3:00 P.M., a pharmacist received an order to add 30 mEq/L of potassium chloride to the already running intravenous fluid for a patient. After checking

    Read More

  12. SILICONE RINGS IN A CLEAN ROOM

    Mar 20, 18 08:39 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

  13. What is a "Root Cause Analysis"? And how does a pharmacy create "healthy safety culture"?

    Mar 20, 18 08:38 PM

    Recently there was a wrong-drug mistake at the pharmacy I'm employed at as a technician. One of my tech friends (who works at a different pharmacy) asked

    Read More

  14. Liquid Morphine: How many days will my meds last?

    Mar 20, 18 08:32 PM

    I am a post surgical patient I am on liquid morphine 22ml bottle. I’m allowed to take 2ml every 3 hours how many days should by bottle last?

    Read More

  15. 1ml inject once a week 10 week supply

    Mar 20, 18 08:26 PM

    how many day supply is it?

    Read More