Insurance Adjudication Simulation Across Multiple Institutions and Levels of Learners

Abstract

Objective. A virtual educational innovation was designed and implemented to have student pharmacists simulate insurance processing. This article describes the impact of this third-party payer simulation on student knowledge and confidence and reports student perceptions of the activity.Methods. First-, second-, and third-year pharmacy students (P1, P2, and P3 students, respectively) at four institutions completed the self-paced simulation. Knowledge was assessed by comparing results of multiple-choice questions on the pre- and post-assessments and evaluated by the Wilcoxon signed rank test. Confidence was assessed by students' change in self-reported confidence scale measurements and compared using the chi-square test.Results. The simulation had a significant impact on student knowledge. The largest improvement was in P1 students, with a pre- to post-assessment average score difference (scale 0-100) of 16.6 compared to 7.2 for P2 and 10.2 for P3 students. Significant improvement was seen on most of the knowledge questions, with variations for certain questions between groups. All groups had significantly improved self-rated confidence in their abilities. Most students agreed that they would recommend this activity to other students (91.7%) and that it encouraged them to think about the material in a new way (85%).Conclusions. Through an innovative simulation on prescription insurance processing, positive results were seen across all three levels of learners. Knowledge assessments significantly improved, and student confidence increased across all groups and all confidence items. Participants would recommend this activity to other students and felt it was an effective way to learn about insurance adjudication.

Keywords: community pharmacy; insurance; simulation; skills laboratory; third-party payer.

Figure 1.

Choose Your Own Adventure (CYOA) insurance processing simulation activity for pharmacy students.