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Revised January, 2010 CONFIDENTIAL AND PROPRIETARY - page 11 / 31





11 / 31


If the claim is rejected, Walgreens Health Initiatives will identify the reason(s) via POS System messaging. BIN Number and Carrier ID: When submitting claims through a POS System, you are required to submit a BIN number and carrier ID. The BIN number is 603286; the carrier ID (PCN) for Walgreens Health Initiatives is 01410000, unless otherwise specified by plan. These numbers must be submitted with every claim. Your system vendor can tell you how to input these numbers. Reversals: If you need to resubmit a claim previously accepted through the POS System, you must first submit a reversal. You must also submit a reversal when a member fails to pick up a filled prescription within ten days. Please refer to your system documentation or vendor for information about submitting reversals. Troubleshooting: If your pharmacy system or POS System is unable to make a connection with the claim processor’s computer system, contact your communication network vendor or switch vendor. If you have any questions regarding a rejected claim or reimbursement please contact the Walgreens Customer Care Center (800-207- 2568). Please have your NCPDP number and other relevant claims processing information available.

Billing Compounds

A compounded prescription contains two or more ingredients in which at least one of the ingredients is a federal legend drug and the compound being made is not available commercially. When submitting a compound claim to Walgreens Health Initiatives:

  • Identify the claim as a compound utilizing the appropriate compound indicator per the NCPDP 5.1 compound code field

  • The pharmacy may submit the NCPDP 5.1 Compound Segment to support the multiple ingredients

  • If the pharmacy cannot submit multiple ingredients, it may enter the valid NDC number of the most expensive legend drug per unit (tablet, capsule, vial, ml, and gram) that is in the compound. In such case:

    • o

      The total quantity entered should be equal to the total amount (tablet, capsule, vial, ml, and gram) of the most expensive NDC used.

      • o

        When calculating and submitting the ingredient cost, enter the combined cost for all ingredients used during the compounding procedure, not to include any costs for labor, equipment fees, professional fees, flavoring, and/or products that are used to administer compounds (e.g., Hep-loc, NS

        • 0.9

          % flush syringes).

  • Medications requiring reconstitution prior to dispensing (e.g., powdered oral antibiotics, etc.) will not be recognized as compounded medications.

Walgreens Health Initiatives – Pharmacy Manual


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