A test strip refill receives a “Rejected” response in RxConnect. What should the store do to resolve the rejection(s)?
A Try different quantity, day supply, and/or modifier values until a paid response returns for TPPC 22345
B Attempt to bill to another plan instead of TPPC 22345
C Call the Help Desk if unable to take appropriate resolution action, or unsure how to appropriately resolve
D Delete the script and create a new one to bill via TPPC 22345
The correct answer and explanation is :
The correct answer is C: Call the Help Desk if unable to take appropriate resolution action, or unsure how to appropriately resolve.
Explanation:
When a test strip refill receives a “Rejected” response in a pharmacy claim system like RxConnect, it typically indicates that there is an issue preventing the claim from being processed successfully. The rejection could be due to various reasons, including incorrect information, system errors, or issues with the patient’s insurance plan. Here’s a breakdown of the possible actions:
- Option A (Try different quantity, day supply, and/or modifier values until a paid response returns for TPPC 22345):
- While modifying values like quantity or day supply might be an approach if the rejection is related to incorrect quantities or coding, it’s not always the correct approach. Repeatedly adjusting values without knowing the exact issue can lead to errors or delays, and it may not address the root cause of the rejection.
- Option B (Attempt to bill to another plan instead of TPPC 22345):
- This could be an option if there is evidence that the primary insurance plan (TPPC 22345) is not covering the prescription, or if the plan has specific exclusions. However, changing insurance plans without verifying why the claim was rejected may result in unnecessary complications or denials.
- Option C (Call the Help Desk if unable to take appropriate resolution action, or unsure how to appropriately resolve):
- This is the most appropriate action. If the rejection is unclear, or if the pharmacy is unable to identify why the test strip refill has been rejected, calling the Help Desk can provide expert support. The Help Desk can assist in identifying the cause of the rejection and provide guidance on how to resolve the issue, ensuring that the claim is processed correctly.
- Option D (Delete the script and create a new one to bill via TPPC 22345):
- Deleting and creating a new script may not be necessary, especially if the rejection is related to an issue that can be resolved with proper documentation or clarification. Starting over could waste time and may not address the underlying problem.
In summary, when facing a rejection, it is crucial to first understand the reason behind it. If the issue is not easily identifiable, seeking assistance from the Help Desk is the most effective way to ensure that the issue is resolved properly.