How the heck do you learn inurance/computer systems?

[trailerpark]

Before pharmacy school I volunteered in a hospital pharmacy (never did any insurance or computer stuff there) and during school I intern at a LTC facility, but we have an order entry department so I never deal with insurance there. My first IPPE at CVS (hell) barely let me use the computer, mostly just order entry (QR I believe it was). I'm now at target doing my first APPE and besides the pharmacist it's just me there and I feel like all I do is count and fill. I wanted to learn pdx since I don't know computer systems either, but we got a visit and apparently pdx is going 'bye bye' by the time I graduate and being replaced by what Giant Eagle uses. I'm a third of the way done at Target and feel like just a glorified tech. I do have another retail elective at an independent pharmacy, but c'mon how am I supposed to learn computer systems and insurance...

I feel like no one will want to hire me once I graduate because I'm clueless about insurance and computer systems. Hopefully with 2 years interning at a LTC I can find a job in a place like that, but If I ever get a retail job I'm going to be so fuc*ed!!!! Do the big chains provide enough training to learn the system and insurance if you're hired without ever having worked retail??? This is stressing me out.

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[farmadiazepine]

you learn it the same way you learned how to use a computer. the same way you learned how to use windows or mac. the same way you learned how to type. within a month or 2 you will know everything you need to know...

you really don't have to worry. at all.

 

[jballer91]

Yeah there's no point in learning the intricacies of pdx since few retailers use it and they say it's getting replaced soon (i'll believe it when i see it). So instead maybe ask for a quick overview of how to "read" an insurance card and what to look for when entering that stuff in. Also ask your rph things like what they do with different insurance rejections, how split billing works, part b billing, etc. So overall big picture things that you can keep in mind so you'll have an idea of what to expect next time but yeah it's mostly on the job learning.

 

[jballer91]

I'm now at target doing my first APPE and besides the pharmacist it's just me there and I feel like all I do is count and fill. .

Oh and you really shouldn't just be doing actual filling since it's an APPE rotation. Sure help when you can when it's busy but try to push the teaching aspect to your preceptor and usually they're receptive to it.

 

[rx2010]

Most companies have their own computer system, so the system you learn on your rotation may not be the same as the one you might be working for when you graduate if it's a different company. They will train you before setting you free, but you will have to learn on the job. As for insurance, I don't think you can learn how to solve all the insurance adjudications during your training, insurance is something you learn with experience. Just ask the tech for help, if they don't know how to solve it, you can always call the insurance company to see why it's rejecting. I had no retail experience at all and my first job as a new grad was retail. Don't depend on the tech to handle all the insurance (you might have a tech that doesn't know or no tech working with you at times), ask them questions and learn from them about insurance and try typing the rxs and solving insurance rejections yourself, that's how you learn.

 

[samisab786]

Before pharmacy school I volunteered in a hospital pharmacy (never did any insurance or computer stuff there) and during school I intern at a LTC facility, but we have an order entry department so I never deal with insurance there. My first IPPE at CVS (hell) barely let me use the computer, mostly just order entry (QR I believe it was). I'm now at target doing my first APPE and besides the pharmacist it's just me there and I feel like all I do is count and fill. I wanted to learn pdx since I don't know computer systems either, but we got a visit and apparently pdx is going 'bye bye' by the time I graduate and being replaced by what Giant Eagle uses. I'm a third of the way done at Target and feel like just a glorified tech. I do have another retail elective at an independent pharmacy, but c'mon how am I supposed to learn computer systems and insurance...

I feel like no one will want to hire me once I graduate because I'm clueless about insurance and computer systems. Hopefully with 2 years interning at a LTC I can find a job in a place like that, but If I ever get a retail job I'm going to be so fuc*ed!!!! Do the big chains provide enough training to learn the system and insurance if you're hired without ever having worked retail??? This is stressing me out.

I did my rotation at Target too and I'm ok w/ feeling like a "glorified tech" (though I got to transfer prescriptions, verify CIIs and all that) having no retail experience, I think what I did was a good intro and I did get to use the computer at times to check/verify things. I do think that w/ training and working it will become second nature.

 

[MindOverMatter]

Honestly, your techs are the best reference for insurance issues.

 

[thephoenician88]

what does giant eagle use?

 

[pezdispenser]

Techs can handle most insurance issues but there are some that the pharmacist is supposed to do. Maybe we should start a list on SDN. Here are some:

Disclaimer: inappropriate use of these codes could result in third-party chargebacks to your store.

PPS Professional Pharmacy Services Codes
Sometimes the insurance will identify a DUR issue like a drug-drug (DD) interaction or therapeutic duplication (TD) that you will have to override. Under each DUR code, enter an intervention such as R0 Pharmacist reviewed. Some insurances only accept M0 Prescriber consulted so you are meant to call or "call" the prescriber and document. Then enter the outcome such as 1B Filled as is, or 1G Filled with prescriber approval.

Submission Clarification: 02 Other override
Medco has a lot of these rejects where the message says for example, the dose is too high on a pediatric script, zolpidem 10mg qhs is too much for a geriatric patient, or verify the CrCl is okay or adjust the dose. Call or "call" the prescriber and document, then enter the 02 override code.

Dosage change override
If the rejection is for an early refill but you review the history and there was a dosage change, sometimes you can override it with one of the following Prior Authorization Type 1 codes depending on which insurance it is:
00000000003
45645645641
22222222222

 

[trailerpark]

Thanks everyone. A list is a good idea! Anything helps.

 

[trailerpark]

What exactly is split billing and when is it normally done and when can't you do it?

 

[zelman]

What exactly is split billing and when is it normally done and when can't you do it?

Billing more than one third party. You can usually do it with one or more government policies. For example, if someone has both commercial insurance and state medicaid (odd situation, but common in minors covered by their parent's policy and covered by the state due to a disability), you would bill the commercial policy first, and bill the copayment to medicaid.

 

[rph3664]

Billing more than one third party. You can usually do it with one or more government policies. For example, if someone has both commercial insurance and state medicaid (odd situation, but common in minors covered by their parent's policy and covered by the state due to a disability), you would bill the commercial policy first, and bill the copayment to medicaid.

I also encountered some of that with children who had divorced parents; the non-custodial parent had private insurance on the children, but the custodial parent was eligible for Medicaid. There were also quite a few women who had insurance but were eligible for Medicaid while they were pregnant.

 

[owlegrad]

Billing more than one third party. You can usually do it with one or more government policies. For example, if someone has both commercial insurance and state medicaid (odd situation, but common in minors covered by their parent's policy and covered by the state due to a disability), you would bill the commercial policy first, and bill the copayment to medicaid.

I think the more common situation is private insurance+copay assistance card?

 

[BenJammin]

Oh and you really shouldn't just be doing actual filling since it's an APPE rotation. Sure help when you can when it's busy but try to push the teaching aspect to your preceptor and usually they're receptive to it.

Hahahahaha! Oh man you're delusional.

 

[samisab786]

Hahahahaha! Oh man you're delusional.

not sure what's really wrong with that statement, he has a point. I did fill, but also did plenty of other things in the pharmacy b/c my preceptor basically said the same thing, as in, should be doing more than just filling.

 

[jballer91]

not sure what's really wrong with that statement, he has a point. I did fill, but also did plenty of other things in the pharmacy b/c my preceptor basically said the same thing, as in, should be doing more than just filling.

Yeah exactly, at my main store when we have APPE students our PIC never has them fill. The most "tech work" they did was answer the phone here and there when it was busy for refills. The focus was more on counseling, dr. calls, helping with audits, etc.

 

[joetrisman]

Depending on the store, the rph, the techs, and the student I could see it going either way. I was fortunate and the rph gave me the go ahead to be "rph" all day every day except doing final verification per board requirements But there are students I wouldn't trust to put the order away.

At the end of the day, I agree with Ben though. Not filling during APPE is ivory tower nonsense.

 

[trailerpark]

I couldn't imagine not having to fill at my APPE rotation with Target. It's just me and the pharmacist and I do all the filling!!! With only the two of us it can get pretty busy. I can't imagine how the pharmacist does it when they're by themselves all day. I wish I didn't have to fill though. Target seems so cheap with their tech hours. We have less than 10 so me and the tech never overlap. I wish there was a full time tech there so I could just do the pharmacist stuff...

 

[owlegrad]

Filling was a pretty small part of my retail APPE and virtually no part of any other.

I will say I can see how it would depend on the student; someone without any retail experience probably needs to do more filling to get an idea of what goes into it. Someone with experience would get more out of other activities. If filling is the majority or even a very large part of your APPE that probably needs to be brought to the APPE director's attention.

 

[pinksparkly]

what does giant eagle use?

I don't know what Giant Eagle uses, but one of my friends works at Target Store #1 and she told me they are going to WIllow (Epic's pharmacy system). At my outpatient hospital job we use Willow and I really like it compared to some of the other systems I've used.

 

[BenJammin]

not sure what's really wrong with that statement, he has a point. I did fill, but also did plenty of other things in the pharmacy b/c my preceptor basically said the same thing, as in, should be doing more than just filling.

No, he doesn't. He said APPE students should not be doing any filling and that is insane. They should be doing things INCLUDING filling.

 

[jballer91]

Before pharmacy school I volunteered in a hospital pharmacy (never did any insurance or computer stuff there) and during school I intern at a LTC facility, but we have an order entry department so I never deal with insurance there. My first IPPE at CVS (hell) barely let me use the computer, mostly just order entry (QR I believe it was). I'm now at target doing my first APPE and besides the pharmacist it's just me there and I feel like all I do is count and fill. I wanted to learn pdx since I don't know computer systems either, but we got a visit and apparently pdx is going 'bye bye' by the time I graduate and being replaced by what Giant Eagle uses. I'm a third of the way done at Target and feel like just a glorified tech. I do have another retail elective at an independent pharmacy, but c'mon how am I supposed to learn computer systems and insurance...

.

Oh and you really shouldn't just be doing actual filling since it's an APPE rotation. Sure help when you can when it's busy but try to push the teaching aspect to your preceptor and usually they're receptive to it.

No, he doesn't. He said APPE students should not be doing any filling and that is insane. They should be doing things INCLUDING filling.

No, I never said an APPE student should do no filling at all, but they definitely should not be filling the majority of the time. And from the sounds of the OP, he or she is spending a large portion of the day filling which doesn't offer much learning opportunity.