Government Agency Submitted Claims. The State acknowledges that government agencies that have issued payment for prescription drug claims may seek eligibility or similar data from Pharmacy Benefit Manager regarding Members, and such government agencies may submit to Pharmacy Benefit Manager claims for reimbursement for prescription drug benefits provided by such government agencies to Members (“Government Claims”). The State authorizes Pharmacy Benefit Manager to provide such eligibility or similar data as lawfully requested by government agencies and further authorizes Pharmacy Benefit Manager to process such Government Claims. The State acknowledges that Pharmacy Benefit Manager may advance payment for Government Claims on behalf of the State, and the State will reimburse Pharmacy Benefit Manager for all amounts advanced by Pharmacy Benefit Manager for payment of Government Claims. Government Claims submitted by or on behalf of a state Medicaid agency shall be paid if submitted within three (3) years from the original date of fill unless a longer period is required by applicable law. In addition, Government Claims submitted by or on behalf of a state Medicaid agency may not be denied on the basis of the format of the Government Claim or failure to present proper documentation at the point-of-sale. The State shall also reimburse Pharmacy Benefit Manager for any adjustments or reconciliations to previously processed Government Claims that may be payable to government agencies in accordance with applicable laws and regulations. Pharmacy Benefit Manager reserves the right to terminate these services upon ninety (90) days’ prior notice to the State upon a change in applicable law governing Government Claims.
Government Agency Submitted Claims. Plan Sponsor acknowledges that government agencies may seek eligibility or similar data from ProAct regarding Plan Participants. Additionally, government agencies, or their agents, may submit to ProAct claims for reimbursement for prescription drug benefits provided by such government agencies to Plan Participants (“Government Claims”). Plan Sponsor authorizes ProAct to provide such data as requested by government agencies or their agents and further authorizes ProAct to process such Government Claims on behalf of Plan Sponsor. Plan Sponsor shall reimburse ProAct for all amounts advanced by ProAct for payment of Government Claims. Plan Sponsor acknowledges that Government Claims submitted by or on behalf of a state Medicaid agency shall be paid if submitted within three (3) years from the original date of fill unless a longer period is required by applicable law. In addition, Government Claims submitted by or on behalf of a state Medicaid agency may not be denied on the basis of the format of the Government Claim or failure to present proper documentation at the point-of-sale. Plan Sponsor shall also reimburse ProAct for any adjustments or reconciliations to previously processed Government Claims that may be payable to government agencies in accordance with applicable laws and regulations. ProAct reserves the right to (i) terminate these services upon ninety (90) days’ prior written notice to Plan Sponsor; or (ii) delegate these services to a third party claims processor.
