Adjudication of Prescription Drug Claims from Network Participants. Prime will process Claims for Prescription Drugs Products and Services electronically submitted by Network Participants through the Claims Adjudication System, according to Benefit Plan benefit and eligibility information submitted by Claim Administrator to Prime and will pay eligible Claims and provide to the submitting entity electronic notification of declined or ineligible Claims. Prime will also process and pay Paper Claims received from a Member at the benefit level set forth in the Benefit Plan, and based on the Allowable Amount, in accordance with the terms of the Benefit Plan, provided that the Benefit Plan allows such reimbursement.
Appears in 4 contracts
Samples: Administrative Services Agreement, Administrative Services Agreement, Administrative Services Agreement
