The Pharmacy Technician: Billing and Reimbursement Microcredential is a Pharmacy Technician Certification Board (PTCB)-recognized education/training program designed to prepare learners for the PTCB Billing and Reimbursement Certificate exam. The curriculum of this pharmacy technician microcredential addresses the following topics:
Insurance programs and eligibility
Pharmacy claims processing and adjudication
Medical claims processing and adjudication
Third-party audits and compliance
Pharmacy Technician: Billing and Reimbursement Microcredential Requirement
Once a learner has completed the educational curriculum, they will have the opportunity to complete an online comprehensive exam. Once the learner passes the exam (minimum 80% passing rate; unlimited attempts permitted), they will earn the Pharmacy Technician: Billing and Reimbursement Microcredential.
The American Society of Health-System Pharmacists is accredited by the Accreditation Council for Pharmacy Education as a provider of continuing pharmacy education with Commendation.
Define common terms related to third-party / health insurance programs.
Explain patient eligibility requirements for the following: Medicare, Medicaid, Veterans Affairs Healthcare, TRICARE, commercial and private insurance plans, and drug manufacturer patient assistance programs.
Define common terms related to pharmacy claim processing, and drug costs and pricing.
Discuss reimbursement policies that are similar among all prescription insurance plans.
Identify information required to submit pharmacy billing claims.
Describe the pharmacy claim submission process.
Recommend strategies for troubleshooting and resolving third-party claim rejections.
Define common terms related to prior authorizations.
Describe the general process for prior authorizations, including information that must be submitted.
Recommend strategies for trouble shooting and resolving issues related to prior authorizations.
Define common terms related to processing medical claims.
Explain the required components of a medical billing claim.
List products and services provided by pharmacies and pharmacists that are billed as medical claims.
Identify information required to submit medical billing claims including, but not limited to, “incident to” billing.
Define common terms related to audits and compliance of pharmacy and medical claim submissions.
List documentation requirements for claims billed to federally funded insurance programs.
Explain the purpose and processes for different types of audits; as well as the federal laws, regulations, and requirements pertaining to the Centers for Medicare and Medicaid Services (CMS) and the Health Resources and Services Administration (HRSA).
Describe quality assurance documentation required for compliance with government agencies, prescription drug plans, and pharmacy benefit managers.
In accordance with our accreditor’s Standards of Integrity and Independence in Accredited Continuing Education, ASHP requires that all individuals in control of content disclose all financial relationships with ineligible companies. An individual has a relevant financial relationship if they have had a financial relationship with an ineligible company in any dollar amount in the past 24 months and the educational content that the individual controls is related to the business lines or products of the ineligible company.
An ineligible company is any entity producing, marketing, re-selling, or distributing health care goods or services consumed by, or used on, patients. The presence or absence of relevant financial relationships will be disclosed to the activity audience.
No one in control of the content of this activity has a relevant financial relationship (RFR) with an ineligible company.
As defined by the Standards of Integrity and Independence in Accredited Continuing Education definition of ineligible company.
Each activity consists of audio, video, and/or PDFs and evaluations. Learners must review all content and complete the evaluations to receive continuing pharmacy education credit for each activity.
Follow the prompts to claim, view, or print the statement of credit within 60 days after completing the activity.
Important Note – ACPE 60 Day Deadline:
Per ACPE requirements, CPE credit must be claimed within 60 days of being earned. To verify that you have completed the required steps and to ensure your credits have been reported to CPE Monitor, check your NABP eProfile account to validate that your credits were transferred successfully before the ACPE 60-day deadline. After the 60-day deadline, ASHP will no longer be able to award credit for this activity.
