Florida Pharmacy Technician Certification Practice Test

What is the correct way to resolve a tie between two similar Third Party Plans when processing a claim?

1. Ask the patient which plan he/she would like to use

2. Choose between the two plans

3. Call the CVS Contact Support Center

4. Verify that you entered the plan information correctly

The correct answer is: Choose between the two plans

Choosing between the two plans is the correct approach to resolving a tie between similar Third Party Plans when processing a claim. In situations where there is ambiguity regarding which plan should be billed, it is typically the responsibility of the pharmacy technician to make a determination. Given the established policies of the pharmacy, this choice is guided by the terms of the contracts with the third-party payers as well as the expected coverage for the patient. While asking the patient which plan they would prefer to use may seem like an option, it could lead to confusion or misinterpretation of the coverage limits and benefits. Calling the CVS Contact Support Center, although potentially helpful in certain situations, does not resolve the immediate need for decision-making in claim processing. Verifying that the plan information was entered correctly is essential for accuracy, but it does not directly address the issue of determining which plan to use when there is no clear precedence. Therefore, choosing between the two plans is the most practical and efficient method to resolve this claim processing scenario.