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How do I bill the copayment for Part D and Capitated Copayments?

April 26, 2017capitated copayment copayments

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How do I bill the copayment for Part D and Capitated Copayments?

1 Answer

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We are aware that with the new ProviderOne Pharmacy POS system, some pharmacies are having difficulty sending claims through for Part D copayments and capitated copayments. Please be sure you’re following the current Pharmacy Billing Instructions, as indicated below. Enter an 8 in the Other Coverage Code (308-C8) field, and enter only the copayment amount in the Other Amount Claimed Submitted (480-H9) field. Do not submit the COB/Other Payment Segment. Please be sure your system is submitting both fields before contacting our call center. Be aware that you also need to enter the Other Amount Claimed Submitted Count (478-H7) for your claim to be processed.