Also, sometimes if you go to the insurance companies website, they might have the override codes listed there as well.Īs far as “Filled After Coverage Terminated” rejections go, this usually means that the insured patient is no longer covered by that insurance company. It is a good practice to stay on the phone with an insurance representative until you receive a paid claim on your end of things. Other times, a DUR Rejection means calling up the insurance company and they can enter the codes on their end or provide you with the codes to enter on your end. Sometimes, depending on the insurance company, entering override codes (Walgreens will have a copy of these or the pharmacist/other techs should know these) will get the insurance company to pay for a claim. When this happens, the patient usually calls the pharmacy.Īnd a Page on Refill Too Soon Rejections:ĭUR Rejects are different from the previously mentioned rejections. Sometimes the patient will find out from the doctors office. I usually make a note of this on the patient's profile if I have been given it. How long the PA is good for, for example, for 6 months or 1 year. Often when they are notified, they are also told Sometimes prescriber's offices will notify the pharmacy once they hear from the insurance company that the PA has been approved. At this point, if they decide to wait, the prescription usually goes “on file” (or “on hold”) and is not filled.Ģ.) Calling or faxing the prescriber’s office and notifying them so they in turn can call/fax the insurance company and provide them with the clinical information they need.ģ.) Running the prescription again at the patient’s or prescriber’s request. At this point, the patient is given the choice of paying out of pocket for the prescription (some people actually do do this) or waiting for the PA to be approved. I have a page on this site on Prior Auths:ġ.) Notifying the patient. However, I did just answer a question about Walgreen's Intercom Plus Software and you can read about it here: Pointers/Tips on Intercom Plus.Ī few of the most common insurance rejections you will encounter include: Prior Authorizations, Refill Too Soons, DUR (or Drug Utilization Review) rejections, and Filled After Coverage Terminated rejections.įirst, it would be a good idea for you to read about Prescription Insurance: As I have never worked for a Walgreens, I am not sure how they do things. A good part of how to resolve these issues is probably in your handbook or in material that Walgreens employees may have given you when you started. I just started working at Walgreens and I don't know what half of the insurance problems are like what steps am I suppose to take in order to resolve them, like for example a prior authorization or a refill too soon or when to contact an agency?
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