Common use of Claims Submission Clause in Contracts

Claims Submission. PHARMACY shall submit Claims for Covered Prescription Services to Claims Processor, in the manner required hereunder, for adjudication, processing, and payment on behalf of the Plan Sponsors. PHARMACY agrees to submit all claims including those where the Member pays 100% of the cost share of the Covered Medication. PHARMACY shall ensure that transmitted Claims information to Claims Processor is in compliance with the then current requirements adopted by the NCPDP as set forth. PHARMACY shall ensure that Claims for Covered Prescription Services to Claims Processor are submitted via real time, point-of-sale communication. PHARMACY must submit Claims for reimbursement no later than ninety (90) days from the date Covered Prescription Services are rendered to Member. At no time shall PHARMACY be required to submit a Claim sooner than thirty (30) days from the date Covered Prescription Services are rendered to Member. PHARMACY shall ensure that all Claims are timely and cooperate with Claims Processor and/or SOUTHERN SCRIPTS in the adjudication and processing of Claims in a timely and efficient manner. PHARMACY must submit all required information for the Claim, which includes but is not limited to: the Member’s identification number; quantity of the medication dispensed; days supply dispensed, PHARMACY’s NCPDP provider and NPI number; the eleven

Claims Submission. PHARMACY shall submit Claims for Covered Prescription Services to Claims Processor, in the manner required hereunder, for adjudication, processing, and payment on behalf of the Plan Sponsors. PHARMACY agrees to submit all claims including those where the Member pays 100% of the cost share of the Covered Medication. PHARMACY shall ensure that transmitted Claims information to Claims Processor is in compliance with the then current requirements adopted by the NCPDP as set forth. PHARMACY shall ensure that Claims for Covered Prescription Services to Claims Processor are submitted via real time, point-of-sale communication. PHARMACY must submit Claims for reimbursement no later than ninety (90) days from the date Covered Prescription Services are rendered to Member. At no time shall PHARMACY be required to submit a Claim sooner than thirty (30) days from the date Covered Prescription Services are rendered to Member. PHARMACY shall ensure that all Claims are timely and cooperate with Claims Processor and/or SOUTHERN SCRIPTS MAKORX in the adjudication and processing of Claims in a timely and efficient manner. PHARMACY must submit all required information for the Claim, which includes but is not limited to: the Member’s identification number; quantity of the medication dispensed; days supply dispensed, PHARMACY’s NCPDP provider and NPI number; the eleveneleven (11) digit NDC of the actual bottle size, package size, or container from which the medication was dispensed from PHARMACY’s stock; the correct DAW code in accordance with NCPDP specifications, the valid prescriber’s NPI number; Tax amounts; and the PHARMACY’s Usual and Customary charge of the medication dispensed.