Instructor: Mrs. T. Thornton-Wyckoff, BBA, CPhT

Email: thorntontn@lamarpa.edu

Phone: 409-984-6437

Office Hours: By Appointment

Additional Contact Information:

 Overview of the qualifications, operational guidelines, and job duties of a pharmacy technician.

Medical Insurance for Pharmacy Technicians

 ISBN-13: 978-0-07-337416-1

Author(s): Cynthia Newby & Janet Liles McGraw-Hill Publishing

Textbook Purchasing Statement: A student attending Lamar State College Port Arthur is not under any obligation to purchase a textbook from the college-affiliated bookstore. The same textbook may also be available from an independent retailer, including an online retailer.

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• Describe the factors that changed the focus of manage care
• Discuss the benefits of managed care
• Identify the needs of individuals who are not insurance eligible
• Define the most common manage care terms
• Determine the charges of a prescription order
• Communicate with third party administrators to determine coverage and obtain prior authorizations
• List Pharmacy Technician responsibilities to assist increasing the amount of managed care reimbursement to pharmacies

Chapter 1: From Prescription to Payment

Chapter 2: Medicolegal Issues and the Pharmacy

Chapter 3: Private Insurance Payers and Plans

Chapter 4: Medicare

Chapter 5: Medicaid, TRICARE, CHAMPVA, WCTX and Discount Card Programs

Chapter 6: Claim Preparation and Transmission

Chapter 7: Processing Claims and Reconciling Accounts

I. From Prescription to Payment

·        The Importance of Pharmacy Benefits

·        Medical Insurance Basics

·        The Pharmacy Practice Billing

·        Procedures, Communication, and Information Technology in the Billing Cycle

·        Effects of Pharmacy Claim Errors

II. Medicolegal Issues and the Pharmacy

·        Health Care Regulation

·        Pharmacy Records

·        HIPPA

·        Other Legislation Affecting Pharmacy

·        Fraud and Abuse Regulations

III. Private Insurance Payers and Plans

·        Private Insurance

·        Types of Health Plans

·        Pharmacy Plan Benefits

·        Pharmacy Benefit Management Techniques

·        Calculating Charges

IV. Medicare

·        Medicare Overview

·        Medicare Part B Plans

·        Who Pays First?

·        Medicare Part D

V. Medicaid, TRICARE, CHAMPVA, WCTX and Discount Card

·        Medicaid

·        TRICARE and CHAMPVA

·        Worker’s Compensation

·        Discount Card Programs

VI. Claim Preparation and Transmission

·        Claim Content

·        Creating Claims

·        Other Types of Pharmacy Billing

VII. Processing Claims and Reconciling Accounts

·        Payer Processing of Claims

·        Remittance Advice

·        Collecting Patient POS Payment

·        Account Reconciliation

·        Audits 

Course Introduction

Syllabus Review  

From Prescription to Payment (Chp.1)

~Chapter Review Assignment

Medicolegal Issues and the Pharmacy (Chp.2)

~Chapter Review Assignment 

Quiz #1 (Chp.1-2)

Private Insurance Payers and Plans (Chp.3)

~Chapter Review Assignment

Exam #1 (Chp.1-3)

Medicare (Chp.4)

Cont’d

Medicare (Chp.4)

~Chapter Review Assignment

Medicaid, TRICARE, CHAMPVA, WCTX and Discount Card Programs (Chp.5)

Cont’d

Medicaid, TRICARE, CHAMPVA, WCTX and Discount Card Programs (Chp.5)

~Chapter Review Assignment

Quiz #2

Claim Preparation and Transmission (Chp.6)

 ~Chapter Review Assignment

Exam #2 (Chp.4-6) 

Processing Claims and Reconciling Accounts (Chp.7)

~Chapter Review Assignment

Exam #3 (Chp.7)

(Discussion Review)

Final Exam Review Day

Final Exam 

December 7, 2026 12:00-2:00 pm

100-90           A

80-89             B

75-79              C

74-60             D

59 & Below   F

1. Quizzes 20%

2. Exams 25%

3. Final Exam 20%

4. Classwork 15%

5. Attendance 10%

6. Discussion 10%

·       NO CELLPHONES are to be in sight during class lectures or labs and must on silent as students will be allowed to use their cell phones during break time. If there is an emergency or situation, please notify your instructor BEFORE class and you may be allowed to step out of class if need be otherwise Donna Wolfe, AH secretary is available at (409) 984-6366 for emergency contact and will notify the instructor and student.

·       All class and or homework assignments, quizzes, exams, and attendance will be used in calculating your course grade.

·       No late work will be accepted; a student has 24 hours to turn in missed assignments due to an excused absence with proper documentation for absence.

·       If an exam is missed, the student must have proper documentation for absence and the student’s FINAL EXAM grade will count as the missed exam grade as well as final exam grade with the appropriate percentages.

·       If a quiz is missed, you will be allowed to make up the quiz with the proper documentation for absence at a scheduled time per instructor or program director, and a different quiz may be given with the zero being replaced with the quiz grade upon completion.

·       In class activities and participation will include assessments of videos, games, group presentations, EVERYONE is expected to stay engaged as this apart of your class grade.

·       Complete any and all required readings, assignments, and discussions as directed by the instructor.

·       Keep copies of ALL paperwork, including syllabus, handouts, and assignments.

·       Participate actively by reviewing course material, interacting with classmates, and responding promptly in communication with your instructor via school email or by appointment.

·       No grades will be discussed over the phone, as you can make an appointment with your instructor or program coordinator.

·       If you have a complaint about this course which you cannot resolve through discussion with the instructor, please contact Mandee Tucker, Chair Allied Health Department phone: 409-984-6365

·       The following materials are officially PROHIBTED in the classroom meetings for this course: food, drink, or tobacco. This policy agrees with the official college policy; breaks will be given.

·       Students are expected to follow a positive learning environment that promotes focus, respect, and safety for all students. The goal is to ensure clothing choices support academic success and do not distract from the educational process. NO hoodies, caps, hair bonnets, sleepwear, excessively revealing clothes, clothing with inappropriate language, images or symbols are permitted in class. We will always exemplify professionalism within the Pharmacy Technician program.

·       The instructor expects that students to illustrate mature behavior with respect to being responsible for their own actions and being respectful of others. Failure to comply may result in removal from the classroom or the program.

Students should ALWAYS use their LSCPA email account to send messages to instructors and leave an office voicemail.

·       All students are expected to attend class DAILY. A no call, no show will result in a zero for class work/homework assignment, class participation, etc. for the day of absence and cannot be made up.

·       A student who is absent from class more than 3 days (3 times) within the semester may be at risk of being dropped from the program by the Program Coordinator.

1^st Warning- verbal with record of conference

2^nd Warning- written with record of conference

3^rd Warning- written and meeting with Program Coordinator and Allied Health Director

·       Late arrival to class is disruptive, the classroom door is closed at the time class starts, any student arriving at that time will be considered LATE and will not be allowed to enter the classroom, the student then should wait until break time to enter. Material that has been taught will NOT be retaught as students should follow up with their group or partner for class work.

·       Students who arrive after a quiz or exam starts, but before it ends, may take the quiz or exam but will have a deduction of 5 points and no additional time will be given.

·       It is the student's responsibility to notify the instructor of any absence. If unable to reach the instructor in the office, please leave a voicemail AND email using the student's campus email. Absences must be followed up with proper documentation for student records.

*At any time while a student in the Pharmacy Technology Program, two final counseling notes are grounds for immediate dismissal.

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Be sure to check your campus email and Course Homepage using MyLSCPA campus web portal. You can also access your grades, transcripts, academic advisors, degree progress, and other services through MyLSCPA.

Academic honesty is expected from all students, and dishonesty in any form will not be tolerated. Please consult the LSCPA policies (Academic Dishonesty section in the Student Handbook) for consequences of academic dishonesty.

The Americans with Disabilities Act (ADA) is a federal anti-discrimination statute that provides comprehensive civil rights for persons with disabilities. Among other things, this legislation requires that all students with disabilities be guaranteed a learning environment that provides for reasonable accommodation of their disabilities. If you believe you have a disability requiring an accommodation, please contact the Accessibility Services Coordinator, Room 119, in the Ruby Fuller Building. The phone number is (409) 984-6241.

No food or tobacco products are allowed in the classroom. Only students enrolled in the course are allowed in the classroom, except by special instructor permission. Use of electronic devices is prohibited.

This syllabus is part of LSCPA's efforts to comply with Texas House Bill 2504.

As per Texas law and LSCPA policy, all LSCPA employees, including faculty, are required to report allegations or disclosures of child abuse or neglect to the designated authorities, which may include a local or state law enforcement agency or the Texas Department of Family Protective Services. For more information about mandatory reporting requirements, see LSCPA's Policy and Procedure Manual.

LSCPA is committed to establishing and maintaining an environment that is free from all forms of sex discrimination, including sexual harassment, sexual violence, and other forms of sexual misconduct. All LSCPA employees, including faculty, have the responsibility to report disclosures of sexual misconduct, including sexual harassment, sexual assault (including rape and acquaintance rape), domestic violence, dating violence, relationship violence, or stalking, to LSCPA's Title IX Coordinator, whose role is to coordinate the college's response to sexual misconduct. For more information about Title IX protections, faculty reporting responsibilities, options for confidential reporting, and the resources available for support visit LSCPA's Title IX website.

For more information about the Clery Act and crime reporting, see the Annual Security & Fire Safety Report and the Campus Security website.

If you have a grievance, complaint, or concern about this course that has not been resolved through discussion with the Instructor, please consult the Department Chair.