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Red Nucleus Training Institute

Providing on-demand training solutions

Claims Adjudication

Claims Adjudication

Claims Adjudication

~12 min | Market Access Academy

In between a doctor writing a prescription and a patient getting their medication, a pharmacy will submit an insurance claim—but then what? This module will discuss claim adjudication and explain why health plans deny claims submitted by a pharmacy and how this can affect a patient’s access to medication.

Module Details

At the completion of this module, you should be able to
• Define claim adjudication
• List reasons why health plans might deny a pharmacy’s claim
• Recall how claim denials can affect prescriptions


• Fully responsive, scrollable e-learning that auto-scales for use on cell phones
• Module-level learning objectives, summary, and self-check questions
• Interspersed interactive learning exercises
• Annual updates
• SCORM compliant

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