PREPARE & APPLY
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A Step Toward Your Advanced CPhT (CPhT-Adv)
Earning this certificate takes you one step closer to becoming a PTCB Advanced Certified Pharmacy Technician™ (CPhT-Adv™). Active PTCB CPhTs who have completed at least four of the certificate programs, or three certificate programs and the Compounded Sterile Preparation Technician® (CSPT®) Certification, and 3 years of work experience will be eligible to earn a CPhT-Adv credential.
Eligibility Requirements
A candidate must hold an active PTCB CPhT Certification and fulfill one of the following eligibility pathways:
Pathway 1: Completion of PTCB-Recognized Education/Training Program for the Billing and Reimbursement Certificate and at least 6 months of experience as a pharmacy technician, at least 50% of which must be devoted to pharmacy billing and reimbursement activities.
Pathway 2: At least 12 months of full-time employment with pharmacy technician experience; at least 50% of which must be devoted to pharmacy billing and reimbursement activities.
PTCB-Recognized Programs have been reviewed and found to provide learners with foundational knowledge that will help them be successful on PTCB exams. Please note that PTCB-Recognized Programs may not cover all information that appears on your exam. It is important that you review the exam content outline as part of your preparation and seek supplemental resources as needed.
Educational Requirement
One of the eligibility pathways for this certificate program includes completing a PTCB-Recognized Education/Training Program for the Billing and Reimbursement Certificate. PTCB Recognized Education/Training Programs meet the curriculum requirements as documented by PTCB.
View a list of PTCB-Recognized Education/Training Programs for the Billing and Reimbursement Certificate.
Please note that additional PTCB-Recognized Education/Training Programs for Billing and Reimbursement will be added to the list as they become available.
Exam Fee
The cost to apply for this certificate exam is $89.
How to Apply and Schedule
- Apply by logging into your PTCB Account.
- Once your application is approved, you will receive an email with your authorization to schedule your exam.
The Billing and Reimbursement Certificate Exam is administered through online proctored testing and in-person at more than 1,400 Pearson Professional Centers nationwide, including more than 100 military on-base sites.
Candidates are required to complete and upload the Supervisor Attestation Form for the PTCB Billing and Reimbursement Certificate Program at the time of application submission.
Prepare for Your Exam
Online Testing Requirements Overview
This quick video explains the requirements and policies for online proctored testing.
Pearson VUE Tutorial
The Pearson VUE tutorial provides a preview of the testing experience and functionality for PTCB exams.
Exam Content Outline
Be sure to review the exam content outline as part of your exam preparation.
Programs and Eligibility (20%) |
Programs and eligibility terminology |
Third-party reimbursement types (e.g., PBM, medication assistance programs, self-pay) |
Healthcare reimbursement systems in different settings (e.g. home health, long-term care, home infusion, health systems, community pharmacy, and ambulatory clinics) |
Eligibility requirements for private and/or federally-funded insurance programs (e.g., Medicare, TRICARE, Medicaid) |
Eligibility for patient assistance through available programs (eg. a 340B eligible program) |
Claims Processing and Adjudication​ (48%) |
Pharmacy/medical claim processing terminology |
Information needed to submit pharmacy/medical claims |
General pharmacy claim submission process (e.g., data entry, verification, adjudication) |
Third-party claim rejection trouble-shooting and resolution |
Methods for determining drug cost and sale prices (e.g., AWP, dispensing fees, gross and net profit, acquisition cost |
Coordination of benefits or plan limitations to determine each party’s responsibility |
Reimbursement policies for all plans being billed, regardless of contracted payers, HMOs, PPO, CMS, or commercial plans |
Identification of formulary coverage or alternatives |
340B terminology |
Prior Authorization (20%) |
Prior authorization terminology |
Information needed to submit medical/pharmacy prior authorization (e.g., patient and prescriber information, drug, dose) |
General process of prior authorization (e.g., from formulary alternatives to contacting the provider, then through payer to patient) |
Third-party prior authorization rejection trouble-shooting and resolution |
Audits and Compliance (12%) |
Audit and compliance terminology |
Contract documentation for claims billed to specific insurance plans (e.g., ICD-10 codes, provider feedback and authorizations to change medications) |
Federal laws/regulations regarding audits (e.g., mandated audits by CMS for all government funded programs) |
Accrediting bodies and surveys (e.g., URAC, TJC, CMS, DNV) |