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Prescription drug claim appeals process

Friday, October 13, 2017   (0 Comments)
Posted by: Janet Anderson
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Good news for small/independent pharmacies!

The Office of the Insurance Commissioner (OIC) has a new prescription drug claim appeals process specifically set up for you! The new process allows pharmacies with less than 14 stores in Washington to file prescription drug claim appeals for underpayment by Pharmacy Benefit Managers (PBMs.) If after your first appeal to the PBM, and you are not satisfied with the outcome or have not heard from the PBM regarding your appeal, try this secondary option.

Here is how it works!

Simply go to: Scroll down and find “Appeal a small pharmacy reimbursement decision.”

The site will take you step by step through the process. It does require a bit of time, but once you set it up, you will be in the system to make future appeals easier.

If you want a step by step walk through, simply call the Office of the Insurance Commissioner.

Call 800-562-6900, 8 a.m. to 5 p.m., Monday – Friday.  They have staff on hand ready and willing to help you!

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