Third-Party Billing is the most difficult task retail pharmacy technicians will face once they are in the field. Due to patient privacy issues, the ever-changing requirements of PBMs (Pharmacy Benefit Manager) to accept a paid claim, it's unfortunately not a subject that can be taught appropriately in a classroom setting. However it is the third-party billing rejections you receive once adjudication has been submitted, that can impose a delay in therapy for a patient, lead to the patient paying exceeded out-of-pocket costs, or even lose a patient's business if a resolution cannot be reached within an appropriate amount of time.
I know far too well how stressful it can be to explain to a patient the (usually, ridiculous) reasons why their prescription claim is not being accepted by their insurance, and what actions can be taken to resolve the issue. I've been a retail pharmacy technician in California for the past twelve years, and in that time I have gained a thorough knowledge of pharmacy billing software and the quickest ways to remedy a rejection from various insurance plans and carriers.
So with that being said, I am preparing to launch a website that will work as a "PBM Cheat Sheet", to provide my fellow pharmacy technicians with an online reference that they can access and review --before making a call to a representative at the insurance company. Most rejections that I have experience with in California, either can be over-ridden by simple coding and notation that you take care of on your own without any third-party support. Others can be resolved quicker than you would expect, if you know the right thing to say to the representative when calling for third-party support.
I am prepared to launch this site soon, but in the meantime I wanted to inquire you other technicians out there, if..a) do you think this website could be helpful for you at your job? and, b) what billing issues do you usually have questions about? I would be happy to answer!