Pharmacy Claims File Only Sample Clauses

Pharmacy Claims File Only. Healthstat Rx Claims Fields Requested Please include your file layout and any definitions/descriptions. Data should be in HIPAA-compliant format wherever possible. Description Comment Requirement Group Number Required Subgroup Number Optional Rx Claim Number Required Prescription Sequence Line number for claim lines that belong to the same claim number - required if used Required Paid Date MM/DD/YYYY - Critical Required Date of service / Date Prescription Filled MM/DD/YYYY Required Process Date MM/DD/YYYY Optional Patient's SSN Required Patient's Last Name Required Patient's First Name Required Patient's Middle Name Optional Patient's Gender Required Patient's Date of Birth MM/DD/YYYY Required Patient's City Optional Patient's State Optional Patient's Zip Code Optional Patient Relationship to Policy Holder Employee, Spouse, or Dependent Required Dependent Suffix Code to identify uniquely each member on the policy. Sometimes called Dependent Number or Person Code. A typical code would be "01" for the policy holder, "02" for the spouse, and "03" and higher for children. Required Policy Holder Number This must be the identifier included in the Healthstat demographic file for matching claims data to the policy holder. This ID may be the SSN, but it may be the insurance carrier's internal member ID or the company's employee ID. Other terms for Policy Holder are Subscriber, Insured, and Employee. Required Policy Xxxxxx's SSN Required in addition to Policy Holder Number Required Policy Xxxxxx's Last Name Required Policy Xxxxxx's First Name Required Policy Xxxxxx's Gender Required Policy Holder's Date of Birth MM/DD/YYYY Required Policy Holder's Zip Code Optional Pharmacy Number Optional National Drug Code NDC Required Drug Name Required Ordering Physician DEA number of prescribing physician Optional Drug Quantity Required Generic Indicator Required Days’ Supply Required Amount Requested Amount requested by the pharmacy Optional Amount Allowed Amount allowed under the plan Required Paid Amount Amount paid by the plan Required Primary Diagnosis Code ICD9 Diagnosis Codes Optional *Claims data cannot be processed unless the demographic data files and any claims files contain the same unique identifier (usually SSN) for each covered member, including dependents. The employee’s SSN or employee ID is used to link dependents to employees, but it is not sufficient to link claims to the appropriate member when dependents are covered. If the dependent’s SSN is not available...
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Related to Pharmacy Claims File Only

  • Insurance The Company and the Subsidiaries are insured by insurers of recognized financial responsibility against such losses and risks and in such amounts as are prudent and customary in the businesses in which the Company and the Subsidiaries are engaged, including, but not limited to, directors and officers insurance coverage. Neither the Company nor any Subsidiary has any reason to believe that it will not be able to renew its existing insurance coverage as and when such coverage expires or to obtain similar coverage from similar insurers as may be necessary to continue its business without a significant increase in cost.

  • Notices Any notice, request or other document required or permitted to be given or delivered to the Holder by the Company shall be delivered in accordance with the notice provisions of the Purchase Agreement.

  • Termination This Agreement may be terminated at any time prior to the Closing:

  • General All payments to be made by the Borrower shall be made without condition or deduction for any counterclaim, defense, recoupment or setoff. Except as otherwise expressly provided herein, all payments by the Borrower hereunder shall be made to the Administrative Agent, for the account of the respective Lenders to which such payment is owed, at the Administrative Agent’s Office in Dollars and in immediately available funds not later than 2:00 p.m. on the date specified herein. The Administrative Agent will promptly distribute to each Lender its Applicable Percentage (or other applicable share as provided herein) of such payment in like funds as received by wire transfer to such Lender’s Lending Office. All payments received by the Administrative Agent after 2:00 p.m. shall be deemed received on the next succeeding Business Day and any applicable interest or fee shall continue to accrue. If any payment to be made by the Borrower shall come due on a day other than a Business Day, payment shall be made on the next following Business Day, and such extension of time shall be reflected in computing interest or fees, as the case may be.

  • Entire Agreement This Agreement constitutes the entire agreement between the parties hereto with respect to the subject matter contained in this Agreement and supersedes all prior agreements, understandings and negotiations between the parties.

  • Definitions For purposes of this Agreement:

  • WHEREAS the Company desires the Warrant Agent to act on behalf of the Company, and the Warrant Agent is willing to so act, in connection with the issuance, registration, transfer, exchange, redemption and exercise of the Warrants; and

  • Severability Any provision of this Agreement that is prohibited or unenforceable in any jurisdiction shall, as to such jurisdiction, be ineffective to the extent of such prohibition or unenforceability without invalidating the remaining provisions hereof, and any such prohibition or unenforceability in any jurisdiction shall not invalidate or render unenforceable such provision in any other jurisdiction.

  • IN WITNESS WHEREOF the parties hereto have executed this Agreement as of the day and year first above written.

  • NOW, THEREFORE the parties hereto agree as follows:

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