# CTE Resource Center - Verso - Pharmacy Technician II Task 892628054

CTE Resource Center - Verso

Virginia’s CTE Resource Center

Communicate with third-party payers to determine coverage, rejected claims, or prior authorizations.

Definition

Communication with third-party payers (e.g., insurance or managed care companies) should be conducted with professionalism via
  • telephone
  • letter
  • e-mail
  • faxes
  • electronic formats
  • mobile devices (e.g., text messages).

Process/Skill Questions

  • What are some common reasons for rejected claims?
  • What are the most common prior authorization procedures?
  • How would a pharmacy technician communicate with patients, third-party payers, and others regarding medication coverage?
  • How does the HIPAA limit what information may be communicated to the patient regarding rejected claims and cancelled policies?
  • What is the pharmacy benefits manager’s role in the adjudication of claims?
  • What is the pharmacy benefits manager’s relationship to a third party payer?

Related Standards of Learning

English

11.1

The student will make planned informative and persuasive multimodal, interactive presentations collaboratively and individually.
  1. Select and effectively use multimodal tools to design and develop presentation content.
  2. Credit information sources.
  3. Demonstrate the ability to work collaboratively with diverse teams.
  4. Respond thoughtfully and tactfully to diverse perspectives, summarizing points of agreement and disagreement.
  5. Use a variety of strategies to listen actively and speak using appropriate discussion rules with awareness of verbal and nonverbal cues.
  6. Anticipate and address alternative or opposing perspectives and counterclaims.
  7. Evaluate the various techniques used to construct arguments in multimodal presentations.
  8. Use vocabulary appropriate to the topic, audience, and purpose.
  9. Evaluate effectiveness of multimodal presentations.

11.5

The student will read, interpret, analyze, and evaluate a variety of nonfiction texts including employment documents and technical writing.
  1. Apply information from texts to clarify understanding of concepts.
  2. Read and correctly interpret an application for employment, workplace documents, or an application for college admission.
  3. Analyze technical writing for clarity.
  4. Paraphrase and synthesize ideas within and between texts.
  5. Draw conclusions and make inferences on explicit and implied information using textual support.
  6. Analyze multiple texts addressing the same topic to determine how authors reach similar or different conclusions.
  7. Analyze false premises, claims, counterclaims, and other evidence in persuasive writing.
  8. Recognize and analyze use of ambiguity, contradiction, paradox, irony, sarcasm, overstatement, and understatement in text.
  9. Generate and respond logically to literal, inferential, evaluative, synthesizing, and critical thinking questions about the text(s).

12.1

The student will make planned persuasive/argumentative, multimodal, interactive presentations collaboratively and individually.
  1. Select and effectively use multimodal tools to design and develop presentation content.
  2. Credit information sources.
  3. Demonstrate the ability to work collaboratively with diverse teams.
  4. Anticipate and address alternative or opposing perspectives and counterclaims.
  5. Evaluate the various techniques used to construct arguments in multimodal presentations.
  6. Use a variety of strategies to listen actively and speak using appropriate discussion rules with awareness of verbal and nonverbal cues.
  7. Critique effectiveness of multimodal presentations.

12.5

The student will read, interpret, analyze, and evaluate a variety of nonfiction texts.
  1. Use critical thinking to generate and respond logically to literal, inferential, and evaluative questions about the text(s).
  2. Identify and synthesize resources to make decisions, complete tasks, and solve specific problems.
  3. Analyze multiple texts addressing the same topic to determine how authors reach similar or different conclusions.
  4. Recognize and analyze use of ambiguity, contradiction, paradox, irony, overstatement, and understatement in text.
  5. Analyze false premises claims, counterclaims, and other evidence in persuasive writing.

History and Social Science

GOVT.16

The student will apply social science skills to understand that in a democratic republic, thoughtful and effective participation in civic life is characterized by

  1. exercising personal character traits such as trustworthiness, responsibility, and honesty;
  2. obeying the law and paying taxes;
  3. serving as a juror;
  4. participating in the political process and voting in local, state, and national elections;
  5. performing public service;
  6. keeping informed about current issues;
  7. respecting differing opinions and the rights of others;
  8. practicing personal and fiscal responsibility;
  9. demonstrating the knowledge, skills, and attitudes that foster the responsible and respectful use of digital media; and
  10. practicing patriotism.

Other Related Standards

HOSA Competitive Events

Health Science Events

 

Medical Spelling

 

Medical Terminology

 

Pharmacy Technician Certification Board (PTCB) Examination Required Knowledge

I. Assisting the Pharmacist in Serving Patients

 

 

I.1. Knowledge of federal, state, and/or practice site regulations, codes of ethics, and standards pertaining to the practice of pharmacy

 

I.2. Knowledge of pharmaceutical, medical, and legal developments which impact on the practice of pharmacy

 

I.5. Knowledge of generic and brand names of pharmaceuticals

 

I.6. Knowledge of therapeutic equivalence

 

I.12. Knowledge of drug interactions (such as drug-disease, drug-drug, drug-laboratory, drug-nutrient)

 

I.15. Knowledge of drug information sources including printed and electronic reference materials

 

I.16. Knowledge of pharmacology (for example, mechanism of action)

 

I.17. Knowledge of common and severe side or adverse effects, allergies, and therapeutic contraindications associated with medications

 

I.18. Knowledge of drug indications

 

I.20. Knowledge of practice site policies and procedures regarding prescriptions or medication orders

 

I.72. Knowledge of communication techniques

 

I.73. Knowledge of confidentiality requirements