A pharmacy technician should identify that which of the following refers to submitting a patients claim to a third-party payer?

Rationale

Adjudication

Adjudication is the process of submitting a patient’s prescription claim to a third-party payer (such as an insurance company) and receiving a response regarding coverage, copay, or rejection.

A (Adjudication) CORRECT

Correct. This term specifically refers to the electronic processing of a prescription claim by a third-party payer to determine payment or rejection.

B (Prior authorization) YOUR ANSWER

Incorrect. Prior authorization is the process of obtaining approval from the insurance company before dispensing certain medications, not the act of submitting the claim itself.

C (Drug utilization review) YOUR ANSWER

Incorrect. Drug utilization review (DUR) evaluates the appropriateness, safety, and effectiveness of a patient’s medications, not claim submission.

D (Eligibility check) YOUR ANSWER

Incorrect. An eligibility check verifies whether a patient has active insurance coverage, but it does not involve submitting a claim for payment.

Conclusion

Adjudication is the correct term for submitting a patient’s prescription claim to a third-party payer and receiving a coverage determination.

A pharmacy technician should identify that which of the following refers to submitting a patients claim to a third-party payer?

Adjudication

Related Questions

Related Quizzes

How familiar were you with this question?

Report an Issue

Rate this Practice Test