Designated Claim definition
Examples of Designated Claim in a sentence
Compounded prescriptions must be submitted via the Designated Claim Adjudication System per NCPDP D.0 standards for submitting compounded prescriptions.
Pharmacy agrees to submit either the Prescriber’s DEA number or NPI number with each Claim submitted to the Designated Claim Adjudication System.
However, Enrollees may never be billed for any Covered Services (except the applicable Co- payments as set forth on the Designated Claim Adjudication System) provided pursuant to the terms of this Agreement.
For each retail pharmacy prescription or refill covered by this Agreement, Pharmacy will be paid at the rates set forth in this Article I, reduced by any applicable Co-payment the Enrollee is required to pay at the time service is rendered and as conveyed to Pharmacy by the Designated Claim Adjudication System.
Notwithstanding the foregoing, any Designated Losses with respect to Designated Claim I and any Asbestos Losses with respect to the Asbestos Claims described on Exhibit I shall not be subject to the Minimum Amount.
In addition, subject to the pharmacist’s professional judgment, Pharmacy shall comply with the Drug Utilization Review (“DUR”) advice, if any, provided with respect to such Enrollee by the Designated Claim Adjudication System.
GUIDANTRX may refuse to submit to Plan Sponsors any claims which are not submitted via the Designated Claim Adjudication System by Pharmacy as provided above.
Pharmacy agrees to submit its then current Usual and Customary Charge via the Designated Claim Adjudication System with each Claim submission.
When delivering Covered Services to an Enrollee, Pharmacy shall price such services as set forth on Designated Claim Adjudication System.
Pharmacy shall collect all required Co- payments from Enrollees in the amounts set forth on Designated Claim Adjudication System.