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Coordination of Benefits Update Implemented For Pharmacy Claims

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Coordination of Benefits update implemented for pharmacy claims


The Indiana Health Coverage Programs (IHCP) has reviewed and revised the policy for Other Coverage Codes on pharmacy claims and will now accept a value of "1" when the member has no other coverage. The pharmacy must perform due diligence in attempting to obtain third-party liability (TPL) information and direct the member to contact the HP TPL Unit at 1-800-457-4510. However, when other coverage cannot be discovered by the pharmacist, the use of the "Other Coverage Code=1" is permitted.

Listed below are the valid values for Other Coverage Codes from the National Council for Prescription Drug Programs (NCPDP):

Ø = Not specified by patient
1 = No other coverage
2 = Other coverage exists − payment collected
3 = Other coverage billed
4 = Other coverage exists − payment not collected

Questions regarding pharmacy claims should be directed to the Catamaran Clinical/Technical Help Desk at 1-855-577-6317.