CONFIDENTIAL AND PROPRIETARY
Rx Origin Code
Effective 1/1/2010, WHI will reject all new prescription claims for Medicare Part D plans unless they have the following values submitted in field 419 DJ via the NCPDP 5.1 format:
1 - Written 2 - Telephone 3 – Electronic 4 – Facsimile
Null or “0” values will not be accepted for any new Medicare Part D claim. It is WHI’s intent to reject these claims with NCPDP code “33 – Missing/Invalid Rx Origin Code”. We ask that you review all secondary messaging for additional information.
CMS Non-Matched NDC List
CMS has published a list of NDCs that will no longer be covered. Effective 1/1/2010, it is WHI’s intent to reject these claims with NCPDP code “54 – Non-matched NDC Number” for Medicare Part D plans, with the additional message “NDC not FDA listed”.
Processing of Prescription Paper Claim Forms
Each individual claim will be processed as received by the claims processor. Extensive edit checks are made to help ensure proper reimbursement. Claims containing one or more errors will be rejected. The pharmacy may resubmit claims in error within 90 days of original service date to the claim processor for further processing. Adjustments can be made to paid or denied claims. The pharmacy should submit to Walgreens Health Initiatives documentation supporting the pharmacy’s request for a correction, and a copy of the claims processor’s reconciliation highlighting the claims for which you are requesting adjustments.
Medicare Part D checks will be mailed to the pharmacies weekly, while commercial checks will be mailed to pharmacies twice a month, unless the plan sponsor directs WHI to pay more frequently or as may be required by law. EFT payments will be made in accordance with the EFT form returned by the pharmacy. As stated in the Pharmacy Network Agreement, payment will be issued to the pharmacy following receipt of payment from the plan sponsor.
Walgreens Health Initiatives – Pharmacy Manual