CONFIDENTIAL AND PROPRIETARY
To submit claims for BOTH the drug and the administration, the provider must ALSO bill value greater than zero in the “Incentive Fee” field 438-E3 and submit a Professional Service Code of “MA” in field 44Ø-E5.
To submit a claim for the ADMINISTRATION fee only, the provider must submit the NDC for the drug administered, submit a value of ZERO in the Ingredient Cost, and value greater than zero in the “Incentive Fee” field 438-E3 and submit a Professional Service Code of “MA” in field 44Ø-E5.
All claims submitted with NDC’s for vaccines will receive the messaging “Call 1-800- 207-2568 if No Admin Fee Pays”. Please call our help desk if you encounter problems processing for these vaccines and or their administration.
Pharmacy Audit Program
Walgreens Health Initiatives or its delegate has the right to inspect, review, audit, and obtain copies of the pharmacy’s prescription files, signature logs and records. Claims submitted by the pharmacy and adjudicated by Walgreens Health Initiatives are subject to desktop and/or onsite audit. Incorrectly submitted and adjudicated pharmacy claims may result in an adjustment. Walgreens Health Initiatives, on behalf of its clients, may recover overpayments identified through the audit by the following methods: reversing and submitting claims reflecting the overpayment, adjustment against future payment(s), billing or invoicing for amount(s) due, and using collection services. Also, Walgreens Health Initiatives has the right to charge reasonable penalties and fees to cover additional costs associated with the pharmacy’s unpaid audit responsibilities and the pharmacy must pay these charges within 15 days of receipt of invoice. The pharmacy’s refusal or denial to submit to and/or comply with Walgreens Health Initiatives audit process will result in the total charge back of paid claims. Failure to comply with the Walgreens Health Initiatives audit process may also result in suspension of payment and/or possible termination from the network.
Desktop and onsite audit requests are sent via U.S. mail, fax, and/or electronic mail, or via a centralized and designated pharmacy chain contact. Onsite audit notification shall be distributed pursuant to the desktop audit request distribution and shall allow for an approximate two week advance notice of the on-site visit. Pharmacy is required to comply with an onsite audit as scheduled, unless a reasonable cause for rescheduling is provided to and accepted by Walgreens Health Initiatives. Walgreens Health Initiatives reserves the right to remove a pharmacy from the network as a result of noncompliance with audits.
Walgreens Health Initiatives – Pharmacy Manual