Pharmacy Technician how-to
How to Resolve an Insurance Rejection
Rejected claims are a daily reality in retail pharmacy. Knowing the common codes saves time and frustrates fewer patients.
Rejected claims are a daily reality in retail pharmacy. Knowing the common codes saves time and frustrates fewer patients. In short: read; verify; for, then complete the remaining steps below.
Step by step
Read the rejection code and message: common ones include refill too soon, prior authorization required and non-formulary drug.
Verify the insurance information on file is current and entered correctly, including BIN, PCN and group numbers.
For refill too soon, check the last fill date and days’ supply; correct errors or tell the patient when the claim will process.
For a prior authorization, notify the prescriber’s office and explain the process and timeline to the patient.
For non-formulary drugs, ask the pharmacist about therapeutic alternatives to suggest to the prescriber.
Document every action in the patient profile so the next technician can follow up.
Safety reminders for pharmacy technicians
- Verify every product by barcode or NDC before it reaches the pharmacist
- Use gloves and proper ventilation when handling hazardous drugs such as chemotherapy agents (USP <800>)
- Follow DEA rules for receiving, storing and counting controlled substances
- Report errors and near-misses: they help prevent future harm
Key terms
Sig · NDC · DAW · Prior authorization (PA) · Controlled substance · Compounding: see the full pharmacy technician glossary.