|
NEC's health plan clients are always the payer of last resort. Therefore, if a patient has a primary payer, such as Medicaid, claims will be sent to Medicaid, unless the patient's prescription benefits are opened with NEC or authorized to be paid by the health plan.
Managing Primary Payer claims are handled in two ways. The first is by prevention - closing prescription benefits to a patient who has coverage such as Medicaid or other insurance. The second method is by requesting pharmacies to reverse claims for patients who had a primary payer at the time of claim. NEC generates Resubmission Reports for pharmacies to use in reversing and crediting claims from NEC's health plan clients.
|
