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On-line
Coordination of Benefits to Start Soon
Express Scripts,
our pharmacy benefits administrator, has recently implemented on-line
coordination of claims for persons with more than one insurance
plan.
Members who
are covered under more than one pharmacy plan understand claims
processing can be time consuming. Paper claims are hand-processed
after being routed between the pharmacy, Express Scripts, and two
health insurance plans.
This spring,
Medical Associates Health Plans and Express Scripts will together
introduce electronic coordination of pharmacy benefits for our members.
This on-line system has increased claims efficiency among other
health
plans who’ve adopted the program.
Advantages
include increased efficiency through ‘real-time’ claims
adjudication, increased member satisfaction, cost savings due to
reduced out-of-pocket expenses and lowered administrative costs,
and timely payment to pharmacies.
The new electronic
procedure works as follows:
• The pharmacy submits your claim electronically, billing
the primary payor first.
• After receiving payment from the primary payor, the pharmacy
then transmits the claim to the secondary payor, indicating the
amount already paid.
• As the secondary payor, Express Scripts remits payment,
reduced by the amount already paid by the primary payor and, if
applicable, the member’s copayment.
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