Certification of Pharmacy Technicians (ExCPT) Practice Exam

A "Rejected Claim" with "Invalid Person Code" likely indicates what?

1. The patient is on Medicare

2. The patient has a mail order program

3. The person code does not match the birth date and/or sex in the insurer's system

4. The patient is on Medicaid

The correct answer is: The person code does not match the birth date and/or sex in the insurer's system

A "Rejected Claim" with "Invalid Person Code" typically indicates that there is a mismatch between the information provided on the claim and the records held by the insurer. In this case, the person code is a specific identifier used to verify a patient's identity and eligibility for coverage. If the code does not align with the birth date and/or sex recorded in the insurer's system, the claim will be rejected. This situation underscores the importance of maintaining accurate and updated patient records, as any discrepancies can lead to delays in processing claims, further complicating patient care. The invalid person code reflects issues in verification, which commonly arise during the billing process when the submitted information does not correspond with what the insurance provider has on file for that individual. This context helps clarify why accuracy in data entry and communication with insurers is critical for pharmacy technicians as they navigate insurance claims.