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Multiple Choice Quiz
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1
Approximately how long does the online adjudication process take?
A)A matter of seconds
B)A few hours
C)3 days
D)7-10 days
2
What program reviews incoming claims against the criteria that must be met for a payer to provider reimbursement for a prescription?
A)The pharmacy’s processing program
B)The prescription processing program
C)The payer’s claims processing program
D)The prescriber’s processing program
3
Which of the following criteria do edits check?
A)The eligibility of an individual
B)Whether or not a drug is covered by the patient’s plan
C)The reputation of the pharmacy
D)Both A and B
4
Which of the following is not a common type of administrative edit?
A)Dosage Checks
B)Time Interval
C)Refill-Too-Soon
D)Non-Formulary Products
5
Which of the following is not a common type of safety edit?
A)Days’ Supply/Maximum Quantity
B)Drug-Drug Interaction
C)Coordination of Benefits
D)Age/Gender Contraindications
6
Which of the following are the correct two categories of edits?
A)Administrative and safety
B)Drug and safety
C)Administrative and drug
D)Safety and field
7
What type of edit might indicate to a pharmacist that a patient is taking two doses of medication in a day instead of one?
A)Dosage Checks
B)Refill-Too-Soon
C)Step Therapy
D)High Dollar
8
Under what type of administrative edit might a patient be able to get a brand drug if they are allergic to a component in a generic drug?
A)High Dollar
B)Duplicate Claim
C)Eligibility
D)Step Therapy
9
What can a pharmacy do if it believes that the prescribed medication is safe for a patient after receiving a safety edit?
A)Appeal the edit
B)Resubmit the claim
C)Override the edit
D)Nothing, the pharmacy has no options
10
If an edit cannot be resolved, what financial obligation will fall on the patient?
A)The full cost of the prescription
B)The copayment
C)The coinsurance
D)There will be no cost for the patient





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