Term bank

On capitalizing internal elements of an organization like our “Patient Services” team at CoverMyMeds, here’s what AP says: Use lowercase for internal elements of an organization when they have names that are widely used generic terms: the board of directors of General Motors, the board of trustees of Columbia University, the history department of Harvard University, the sports department of the Daily Citizen-Leader. Capitalize internal elements of an organization when they have names that are not widely used generic terms: the General Assembly of the World Council of Churches, the House of Delegates of the American Medical Association, the House of Bishops and House of Deputies of the Episcopal Church. So, our Patient Services team would be capitalized, but our marketing team would not be.

Telehealth is different from telemedicine in that it refers to a broader scope of remote health care services than telemedicine. Telemedicine refers specifically to remote clinical services, while telehealth can refer to remote non-clinical services.

Telehealth is the distribution of health-related services and information via electronic information and telecommunication technologies. It allows long-distance patient and clinician contact, care, advice, reminders, education, intervention, monitoring, and remote admissions.

Telehealth is different from telemedicine in that it refers to a broader scope of remote health care services than telemedicine. Telemedicine refers specifically to remote clinical services, while telehealth can refer to remote non-clinical services.

THAT or WHICH? "That" is used to indicate a specific object, item, person, situation, etc. "Which" is used to add information to objects, items, people, situations, etc. Because "which" indicates a non-restrictive (optional) clause, it’s usually set off by commas. For example: “CoverMyMeds offers technology solutions that allow providers to save time and help patients” is CORRECT “CoverMyMeds' technology solutions, which allow providers to save time, also help patients” is CORRECT

CoverMyMeds has five target audiences: - Patients - Providers - Pharmacists - Payers - Pharma

They're vs. there vs. their They sound the same, but their meanings are different. “They’re” is a contraction of “they are” - Example: They’re going to the store. “There” typically refers to a location - Example: I want to go there. “Their” shows ownership of something - Example: It’s their new house. Now let’s use them all in a sentence, just for fun: “They’re going over there to pick up their cat.”

An individual or firm hired by an employer to handle claims processing, pay providers, and manage other functions related to the operation of health insurance. The TPA is not the policyholder or the insurer.

A pharmacy audit is a formal review of operations and processes to make sure that pharmacies are compliant with pharmacy regulations and other related agreements. TYPES OF AUDITS: Field/On-Site Audits Field/On-site Audits are performed at the pharmacy and involve physical observations, prescription reviews, inventory, and checks for compliance with Medicare Part D regulations and procedures. The pharmacy usually receives advance notice, but in some rare instances, they can be unannounced, such as for Medicaid. Such audits generally cover claims from the previous 12- 18 months and provide you with a range of prescriptions to have readily available beforehand. Purchase Verification Purchase Verification Audits review the amounts and NDCs of medications that are submitted by pharmacies from wholesale receipts. They are investigational-type audits and are conducted in accordance with Third Party Payer agreements. Investigational Audit A pharmacy is usually contacted by phone or mail and asked to provide photocopies of specific documents and records related to claims paid to pharmacy during a specified period. Documentation may include copies of original prescriptions, signature logs, computer records, and invoices showing purchase or receipt of dispensed medications. These can be as simple as comparing NDCs ordered versus those dispensed to a complex investigation about prescriber, member or pharmacy fraud. Desk/Mail Audits Desk/Mail Audits use automated means to review pharmacy claims and encounter data received by the plan or PBM. This type of audit requires the pharmacy to locate prescription records and send them to the PBM. It's set up to evaluate prescribing patterns, physician referral patterns, utilization overrides, ingredient cost integrity, geographic prescribing reports, payment reports, and billed issues to identify possible abusive or fraudulent activity. Prescriber/Member Audits Prescriber Audits have specific claim information submitted by the pharmacy and are then thoroughly verified by a prescriber/physician to ensure that each party’s records coincide. It's essentially handled the same as a Desk/Mail Audit. Member Audits Member audits are similar to the Prescriber Audit with the exception that the corresponding claims are verified with the patient/customer verification. It's essentially handled the same as a Desk/Mail Audit. Telephone Audits The PBM contacts the pharmacy usually to correct claim billing on a single or small number of claims. It isn't used for large volumes of claims. Failure to comply with a telephone audit will normally result in the PBM reversing the claim and could lead to a desk or on-site audit.

To lower costs, a plan places prescription drugs in its formulary into different "tiers." Your drug copay will vary depending on the tier. For example, one approach to tiers is the following: Tier 1: Generic drugs Tier 2: Preferred brand drugs Tier 3: Non-preferred brand drugs Tier 4: Specialty drugs

Per AP Style, use lowercase a.m. and p.m. — with periods — when writing the time. If it’s an exact hour, no “:00″ is required. For example, “I wake up at 6 a.m. before the sun rises, then get in bed at 9:30 p.m. to read a book.”

Title Case vs. sentence case, when to use. Our brand guidelines call for Title Case formatting for all H1, or main, headlines. Subsequent headlines, like H2s or H3s, should be sentence case. Title Case: This is a Title Case Headline. Sentence case: This is a sentence case headline. If you want to double-check your work, Capitalize My Title is a great tool. Reminder: we follow AP style.

Total amount to be paid by the claims processor (i.e. pharmacy receivable). Represents a sum of ‘Ingredient Cost Paid’ (5Ø6-F6), ‘Dispensing Fee Paid’(5Ø7-F7), ‘Flat Sales Tax Amount Paid’ (558-AW),‘Percentage Sales Tax Amount Paid’ (559-AX), ‘Incentive Amount Paid’ (521-FL), ‘Professional Service Fee Paid’(562-J1), ‘Other Amount Paid’ (565-J4), less ‘Patient Pay Amount’ (5Ø5-F5) and ‘Other (565-J4), less ‘Patient Pay Amount’ (5Ø5-F5) and ‘Other Payer Amount Recognized’(566-J5).

Refers to the National Council for Prescription Drug Programs (NCPDP) pharmacy claims bundle. (4) pharmacy claims may be bundled into (1) transaction for a single patient.

Brand-name drug from Novartis that's used in ScriptHero's brand-direct program

generic version of Travatan Z

[Total or] True out-of-pocket (TrOOP) costs are the expenses that count toward a person’s Medicare drug plan out-of-pocket threshold. TrOOP costs determine when a person’s catastrophic coverage portion of their Medicare Part D prescription drug plan will begin.

Balance transfer to the Medicare Part D network facilitator system. Allows for the real-time routing of Medicare Part D TrOOP and Total Drug Spend Balances between PBMs. Automatically transfer’s a beneficiary’s balance between one Part D plan and another, when the beneficiary changes PBMs. Implemented a new Telecommunications Standard, Financial Information Reporting (FIR) V1.0.