Walgreens Pharmacy Technician Insurance and TPR tips

[lilacturtles]

Hi!

I just started at a Walgreens and have been there for about a week and a half. It's very busy and I am new at everything. I want to know all the different types of insurance that can be entered, the only one I've come across enough times in the short time that I've been here is WISPA. Please, can someone give me a list of the types of insurance and maybe an image that shows what the card for that insurance looks like? I would appreciate it very much.

Any additional TPR things are welcome too as well as computer tips about storenet (the system used).

I'm kind of stressed out about this job because it's so overwhelming-I feel like I'm constantly needing to be helped so I'd appreciate any tips you could give!

Thank you!

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[MyRealNameIs]

Everyone feels that way and no one expects you to be any decent until few months into your job.

Insurances are different depending on what state you are from. I am not familiar with WISPA so I am guessing you are not from California. I can't help you with those

But usually, all you do is enter in the BIN and PCN number to search insurance information if you don't know. I know its a slow method but they shouldn't expect you to be fast.

Keep in mind that when you enter in both BIN and PCN number, the system will only match by BIN. So when you are trying to choose the correct insurance, make sure the PCN doesn't change. Usually it is the first one on the list but not always.

Some insurance requires a person code at the end of their recipient ID number. If the person is the child of the primary card holder, it could be 03, or 003. You may also need to link it to the primary card holder. If primary card holder, 00, 001, or 01.

Some insurance requires you to omit the first few letters. For example if recipient ID is XTR05948354. You may need to enter it as R05948354 or 05948354.

It is pretty complicated and since you are not from my state, I can't really help you with that one.

For TPR, make sure you read the message.

Quantity exceeds limitation, or something to that effect depending on which insurance you are billing is a common issue.
That usually means insurance doesn't want to cover that many days of supply. If it is a 90 day supply or 60 day supply of medication, try changing it to 30 days supply.

Ex. lisinopril # 90, sig +qd.

Leave the quantity as 90, but change the quantity dispensed to 30.


Drug not covered
OTC medication are not covered by most insurances.
If it is not an OTC medication, it probably requires a PA. Ask your tech how to fax the doctor for PA and make sure you leave a note like 9/26 PA FAX and your initial in the comments


Refill too soon
The exception should tell you when the patient picked it up, and the earliest patient can pick up the medication.


What I did when I first started was just print screen, create exception, and give it to another tech or pharmacist to solve it. You are most helpful when you are ringing up customers, putting prescriptions away and filling prescription.

You are least helpful when you are tinkering with insurance or TPR issue for 5 minutes while 10 people at front and 4 people at drive through is waiting. If you don't know, ask immediately for help. It saves time. If pharmacy is busy and you are trying to enter in insurance info and stuck, just ask someone to help you as soon as they can, tell the patient you are new and someone else will come and help them. Then, move on to the next customer.

 

[XX_123]

Hello,
So when patients asked to fill their Rx for 90 days, instead of 30 days, vice versa, can we change the quantity? or Do we have to fax the doctor? or do the patients have to do it themselves?

 

[romaniangirl]

Hello,
So when patients asked to fill their Rx for 90 days, instead of 30 days, vice versa, can we change the quantity? or Do we have to fax the doctor? or do the patients have to do it themselves?

As long as it's not a control, you can just change it yourself. This may vary by state, though.

 

[XX_123]

does that mean you can make changes right at the profile section, the autorefil/90 days button ?

 

[MyRealNameIs]

does that mean you can make changes right at the profile section, the autorefil/90 days button ?

To give an example

Pt brings in a perscription for Metformin
Sig BID, 2 refills

Insurance permitting, the patient has the right to request all 180 pills at once.
To do this, you will type everything normally except

Quantity 60 Quantity Dispensed 180

The system will automatically take off all the refills and allow it to go through.


If the prescription does not have enough refills to allow 90 day supply, then you can go to options -> fill preference -> click Y on 90 day supply when typing the prescription.
The system will automatically fax the doctor request for 90 day supply.

If the patient wants 90 day supply for all of his medication, you will go to autorefill/90 day button.
However, I noticed if you do it this way, it doesn't automatically request 90 day supply right away.
I just like to change fill preference because that will request 90 day supply to doctor right away and I don't have to worry about it.

 

[XX_123]

thanks!

 

[NthonyLam]

somebody please help me !
If a patient has his medication be ready to pick up at his Walgreens location, but he wants to pick up at my store. How do I do that?
Do I go to "Central Profile", select his medication, and click on "Select Rx" and Cash it out to cancel his insurance? and "Refill" it? Plz help. Many thanks

 

[Nina.m11752]

somebody please help me !
If a patient has his medication be ready to pick up at his Walgreens location, but he wants to pick up at my store. How do I do that?
Do I go to "Central Profile", select his medication, and click on "Select Rx" and Cash it out to cancel his insurance? and "Refill" it? Plz help. Many thanks

Okay, so at walgreens got to Central >select rx > fill > (it will most likely reject) select fill AGAIN, and it will pull from the other store and the ins. will cover at your store.