Billing and Reimbursement Essentials is an ACPE-accredited course that provides advanced training on third-party billing and reimbursement for the CPhT and prepares the participant to sit for PTCB's Billing and Reimbursement Certificate exam. Comprised of 4 separate modules, this program is accredited for 4.0 contact hours of ACPE-accredited continuing education.


Course Scheduled Launch Date: October, 2020

Enroll by 9/30/20 and save 10% using coupon code: EARLY10




Learning Objectives: At the completion of this program, participants will be able to:

  • define prior authorization terminology
  • list information needed to submit medical/pharmacy prior authorization
  • describe the general process of prior authorization 
  • perform third-party prior authorization and rejection trouble-shooting and resolution
  • define commonly used terms used in processing and adjudicating prescription claims
  • analyze information needed to successfully submit and process claims for prescriptions and medical devices
  • describe the life cycle of a prescription claim- from order entry to completed claim
  • identify the listed formulary alternatives or plan limitation restrictions to guide prescribers
  • outline reimbursement variations across different payer sources
  • explain the Federal 340B program and related terminology
  • outline third-party reimbursement types (e.g., PBM, medication assistance programs, self-pay)
  • list healthcare reimbursement systems in different settings (e.g. home health, long-term care, home infusion, health systems, community pharmacy, and ambulatory clinics)
  • outline eligibility requirements for federally-funded insurance programs (e.g., Medicare, TRICARE, Medicaid)
  • outline eligibility for patient assistance through available programs (e.g. a 340B eligible program)
  • define common billing audit and compliance terminology
  • recognize documentation needed for claims to be billed and processed with insurance.
  • outline federal laws and/or regulations for billing and reimbursement
  • list billing and reimbursement accrediting bodies and surveys



Accreditation Information: The National Pharmacy Technician Association (NPTA) is accredited by the Accreditation Council for Pharmacy Education as a provider of continuing education. This CPE activity has been designated as a knowledge-based program. No faculty members had any conflicts of interest to disclose.

ACPE UAN: 0384-9999-20-002-H04-T 

4 contact hours/ 0.4 CEU

Release Date: 10-01-2020 Expiration Date: 10-01-2023