Pharmacy Technician Advice/Problems

[SincerelyMe]

Hey experienced pharmacy technicians,

I started working with Walgreens as a Pharmacy Tech about 2 months ago. I've caught on pretty quickly being trained on the spot but I had other questions that maybe you all could help me out with.

1. I don't understand the concept of submitting a direct link (SDL). I know that is how you bill a 3rd party if the prescription was previously sold and there is no way to bill them through IC plus. What other occasions would you need to SDL a prescription and bill the 3rd party manually?

2. Also, with some insurances I get a reject message for the flu shot saying "need to file script manually." In that case what do I do? Do I call the insurance company to verify the information of the patient and ask them for aid or is there another way to handle it?

3. Also, what is the difference between Medicaid and Medicare?

Any help would be greatly appreciated everybody!

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[photografreak]

Thank for posting this! I would like to know the answers as well (started a little less than 2 months ago); hopefully someone out there can help as out.

In regards to medicare vs. medicaid. Medicare is usually for seniors (65 and above) and I think some people with disabilities. Medicaid is for individuals with low-income (age doesn't matter). Some people may have both. Medicare is federal while medicaid is different in every state.

 

[rxtech2012]

When the vaccine gets a reject stating file manual claim, this means that pt needs to pay total out of pocket cost up front then file a claim for reimbursement from their insurance. Problem is: the ins company obviously doesn't have to reimburse anything if they don't want to.

 

[SincerelyMe]

So it's not guaranteed the insurance company will cover it? At this point should I call the insurance company to verify if they will pay for it if they first pay up front? What would you do in this case?

 

[rxtech2012]

No I wouldn't call. Basically I just explain to te customer that they need to pay out of pocket and they need to submit a claim if they want reimbursement. If the vaccine is expensive(zostavax etc) then I would tell them that te decision to reimburse lies completely with the insurance company. Since the flu shot is relatively cheap, they usually don't complain too much.

 

[bp2313]

Hey experienced pharmacy technicians,

I started working with Walgreens as a Pharmacy Tech about 2 months ago. I've caught on pretty quickly being trained on the spot but I had other questions that maybe you all could help me out with.

1. I don't understand the concept of submitting a direct link (SDL). I know that is how you bill a 3rd party if the prescription was previously sold and there is no way to bill them through IC plus. What other occasions would you need to SDL a prescription and bill the 3rd party manually?

2. Also, with some insurances I get a reject message for the flu shot saying "need to file script manually." In that case what do I do? Do I call the insurance company to verify the information of the patient and ask them for aid or is there another way to handle it?

3. Also, what is the difference between Medicaid and Medicare?

Any help would be greatly appreciated everybody!

This is taken directly from a ppt from my Pharmacy Mgmt class (disclaimer)
Medicare: social insurance, patients "pay in", financed through payroll taxes, uniform across the country
Medicaid: welfare based, state & federal fundings from general revenue, need based, state-to-state variations
If you want the whole ppt (short actually), let me know

 

[SincerelyMe]

I would love a copy of your PowerPoint if you could! I'm trying to learn as much as I can so I can get better at my job. PM me if you could send it!

 

[tsjla87]

1. Not sure, never had to deal with it.

2. This is simply a system issue, nothing to do with a patients insurance. Most insurance companies will not pay for a flu shot in a pharmacy. When you get that message, it would only be if the insurance company accepts flu shots in a pharmacy, the reason for the error is because you need to input the same insurance into the patient profile as a separate insurance with a different ID, sort of like workers comp. The pharmacy should have the ID's for all the different insurance companies.

3. I might be wrong on this so please correct me, but from what i understand, medicaid is insurance run through various hospitals and clinics, while medicare is government issued insurance that covers only some health care, example being only begin covered for hospital visits and diabetic medication, and nothing else.

 

[arevinotion]

yeah,I would love a copy of your PowerPoint if you could! I'm trying to learn as much as I can so I can get better at my job