(111) Implementation and Evaluation of Insurance Adjudication Activities in a Skills Lab Curriculum

Objective : To determine the impact of insurance adjudication activities on student’s knowledge and confidence in first- and second-year skills lab courses.

Methods: First- and second-year pharmacy students completed simulated insurance adjudication activities. Faculty created sets of insurance rejects and developed an insurance resolution workstation which was implemented in each weekly lab series. Students had 20 minutes to resolve the insurance rejections in their work queue. Rejections included invalid BIN, refill too soon, maximum days’ supply 30, non-matched cardholder ID, therapeutic alternative, and prior authorization issues. Knowledge was assessed longitudinally by grade comparison. A mixed quantitative-qualitative analysis based on pre-/post-survey questions and student reflections were used to evaluate this activity.

Results: This simulation had a significant impact on both student knowledge and confidence. There was a statistical difference in the mean scores across weeks. Two-sided Wilcoxon signed rank tests were utilized to evaluate survey data. There were significant changes in survey areas related to understanding and ability to resolve refill too soon (3.25 vs. 3.63, p<.001), invalid BIN (3.15 vs. 3.53 p<.001), maximum days’ supply 30 (3.30 vs. 3.70 p<.001), non-matched cardholder ID (3.20 vs. 3.65 p<.001), and prior authorization (2.88 vs. 3.48 p<.001) issues. A systematic thematic analysis was conducted on free-text reflections. Prominent themes that emerged were that insurance adjudication is an essential skill; it promotes patient advocacy; it helps to improve patient’s health outcomes; it encourages effective communication with patients; and it prepares students for community Advanced Pharmacy Practice Experiences (APPEs).

Conclusions: Insurance adjudication is a practical and beneficial activity that strengthened first- and second-year pharmacy students’ skills and increased confidence in their abilities.