Cardholder
ID is invalid. |
Submit
•
Using plan code according to logo
•
Using correct ID number as stated on card
•
Using correct group number
If
still rejected, refer the cardholder to his or her benefits
administrator. |
Cardholder
has termed. |
•
Ask if cardholder presented a current card.
•
Ask if cardholder has other primary coverage.
•
If still rejected, refer the cardholder to his or her benefits
administrator.
|
Member
wants to fill a prescription for a vacation supply or lost medications.
|
•
Call the appropriate pharmacy help desk for assistance to determine
whether group allows for override. |
Prior
authorization is required. |
•
Advise cardholder to have his or her doctor call the customer
service number printed on the card and give the diagnosis.
|
Refill
is too soon. |
•
Change direction for medication. Enter "98798798798" into the prior
authorization field and resubmit the claim.
|
The
prescription is for interferon beta-1b (Betaseron®).
|
•
Submit claims online to HDS (Bin#610500).
•
For assistance with inquiries, contact HDS at 800.750.9835.
|
Day
supply is invalid or quantity is rejected. |
•
Verify that the day supply, directions, and quantity fields
are all consistent with the written prescription.
•
Check online messaging for plan limitations.
|