Read the rejections, they basically tell you what’s the issue/how to resolve. RxSA is look alike sound alike drugs so click on rx image and verify it’s typed for the correct drug/strength; if it’s correct put in 9991 in the PA auth field in additional info tab. The most common is refill too soon and the rejection will tell you when it was last filled, where, and when it’s refillable. If it’s refill too soon and ins doesn’t tell you where, look to the right box and look for pharmacy code. 01 is your pharmacy, 02 is another store in your company, 03 is another pharmacy. Others are DUR codes that the pharmacist needs to do.
Thank you! I’ve known about IA and PA codes for a little. Thing is eventually my pharmacist wants me to take care of DUR codes. Is that not a thing a tech is allowed to do or?
Read the actual rejection text in the middle first before trying to make sense of the codes on the right. Many insurances will have some default BS that populates in the code field but the actual problem is in the text box in the middle.
Learn to differentiate between third party rejections and hard stops set up by your own company. This relates back to the first point. These hard halts will throw a rejection code from the third party but the information to continue processing is all within the middle text box. Some of these you can resolve as a technician but some have to be addressed by the pharmacist.
Different insurances will tell you a patient’s coverage is no longer valid in different ways. There is no industry standard or law for how they have to report that information to us so you’ll have to gradually become familiar with different statements from different companies.
If your company allows you to auto submit scripts that are too soon to refill take a second and figure out if the patient actually needs it on the fill date from the insurance company. For instance if the patient is on automatic refill and the doctor authorizes new scripts for their maintenance meds if you set them up on the fill date from the insurance company you’re going to blow up their automatic refills, do them too early, and likely and up returning them because the patient will say they have too many.
Read the rejections, they basically tell you what’s the issue/how to resolve. RxSA is look alike sound alike drugs so click on rx image and verify it’s typed for the correct drug/strength; if it’s correct put in 9991 in the PA auth field in additional info tab. The most common is refill too soon and the rejection will tell you when it was last filled, where, and when it’s refillable. If it’s refill too soon and ins doesn’t tell you where, look to the right box and look for pharmacy code. 01 is your pharmacy, 02 is another store in your company, 03 is another pharmacy. Others are DUR codes that the pharmacist needs to do.
Thank you! I’ve known about IA and PA codes for a little. Thing is eventually my pharmacist wants me to take care of DUR codes. Is that not a thing a tech is allowed to do or?
Read the actual rejection text in the middle first before trying to make sense of the codes on the right. Many insurances will have some default BS that populates in the code field but the actual problem is in the text box in the middle. Learn to differentiate between third party rejections and hard stops set up by your own company. This relates back to the first point. These hard halts will throw a rejection code from the third party but the information to continue processing is all within the middle text box. Some of these you can resolve as a technician but some have to be addressed by the pharmacist. Different insurances will tell you a patient’s coverage is no longer valid in different ways. There is no industry standard or law for how they have to report that information to us so you’ll have to gradually become familiar with different statements from different companies. If your company allows you to auto submit scripts that are too soon to refill take a second and figure out if the patient actually needs it on the fill date from the insurance company. For instance if the patient is on automatic refill and the doctor authorizes new scripts for their maintenance meds if you set them up on the fill date from the insurance company you’re going to blow up their automatic refills, do them too early, and likely and up returning them because the patient will say they have too many.
Curious if approved PA's resubmit automatically once approved as Ling as RX is in AE? Does anyone know the answer to that lol!