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Related post: Days supply/early Refill 21 Dispensing The same Drug More Than Once In A Five (5) Day Period 21 Replacement supplies Cheap Diclofenac (lost/stolen/spoiled Prescriptions) 22 Procedure For submitting Claims For Diabetic supplies (excluding Diabetic Diclofenac Gel Devices) 22 suggested Monthly Maximums 22 submission & eligibility Guidelines For Compounds 23 Duplicating A Comercially Available Product 23 unlisted Compound Codes 24 Reimbursement Time Guidelines For Compounds 25 Section 5 - Drug utilization Review (DuR) Drug utilization Review (DuR) 29 DuR- How It Works 29 What To Do When The DuR Rejects A Prescription? Diclofenac Mg 30 Section 6 - Audits And The Audit Department Overview: On-site Pharmacy Audits 32 Section 7 - Co-Ordination Of Benefits Provincial Co-Ordination Of Benefits 35 Private Co-Ordination Of Benefits 35 limited use Drugs For Ontario seniors With Private Drug Plan Coverage 35 spouses – 65 Or Over (Alberta) 35 Manitoba And saskatchewan: Provincial Registration Management Program 36 specialty Drug Program (sDP) 36 Section 8 - Drug Plan Types The emegis Assure Claims National Formulary 39 Maximum Allowable Cost Pricing Generic Diclofenac (MAC ) Or Reference Based Pricing (RBP) 40 Section 9 - The Trial, Maintenance And Prior Authorization Programs Trial Drug Program 42 Procedure For Trial Program 42 examples Of Drug Classes Included In Telus Health solutions’ Trial What Is Diclofenac Program 42 Procedure For Maintenance Program 43 Trial And Maintenance Programs Combined 43 Procedure For Combined Trial And Maintenance Programs 43 Prior Authorization Program 43 Procedure For Prior Authorization Program 44 Section 10 - e-Sampling Program Section 11 - PSHCP Appendix 1 Request For Change In Provider Profile 49 Appendix 2 Diabetic Pseudodin list 51 Appendix Purchase Diclofenac 3 Glossary Of Terms 52 Appendix 4 Common Reasons For Rejection 54 Appendix 5 Pins For Common Compounds 55 Section 1 - General Information 1000 de Serigny Longueuil (Québec) J4K 5B1 TELUS Health Solutions Assure Claims Pharmacy Support Centre: 1 800 668-1608 About TELUS Health Solutions TELUS Health Solutions is a leader in telehealth, electronic health records, remote patient monitoring, mobile home and community care, consumer health, benefits management and pharmacy management. Our solutions give health authorities, providers, primary care physicians, patients and consumers the power to enhance decision Diclofenac 50mg making and improve outcomes for Canadians. TELUS Health Solutions is transforming Buy Cheap Diclofenac how information is used across the continuum of care from hospital to home with solutions that foster collaboration, drive prevention and empower care teams and patients. TELUS Health Solutions is Canada’s leading Healthcare IT Company as cited by the Branham Group for the last three years and for being honoured as the ITAC Health Company of the Year (2008) and Health Transformation Company of the Year (2009). For more information about TELUS Health Solutions, please visit www.telushealth.com and www.telushealthspace.com Assure Health Inc. was established in September of 1988. Purchase Diclofenac Online In November of 1999, Emergis Inc. (“Emergis”) acquired Assure Health. In January 2008, TELUS demonstrated its strategic commitment to healthcare with the acquisition of Emergis and now operates as a facility for the electronic submission of “pay-direct” health claims including prescription drug claims from point-of-service to As a part of Buy Diclofenac Online our network, your pharmacy realizes benefits in processing, as follows: Determination of product eligibility for most claims Instant confirmation of coverage of cardholders and their dependents Automated payment of each transaction to a bank account of your choice (Electronic Funds Transfer, “EFT”) Toll-free access to our Pharmacy Support Centre where your questions can be answered and your problems can be resolved TELUS Health Solutions processes claims from pharmacies only by Electronic Data Interchange (EDI). It is our policy that we do not accept paper claims submitted by a pharmacy for reimbursement. EDI processing provides the capability to handle more options to plan designs and formularies, as the system’s “online” facility makes communication of every variation instantaneous. Where provincial plans offer drug benefits to residents, TELUS Health Solutions can co-ordinate the public and private sector obligations, determining the primary payment responsibility, i.e. whether we (on behalf of our insurance carriers) are responsible for the claim, and return that information to you while the cardholder is still at the dispensary. We also provide co-ordination Diclofenac Sodium of claims payment between most private payers. All claims are adjudicated based on the various co-pay and deductible amounts selected by the insurance carriers and their policyholders. This manual identifies the policies that are to be followed for adjudication of claims for TELUS Health Solutions Assure Claims Card cardholders. From time to time, policy changes will be communicated to you through faxed/ mailed/ or electronic updates. These communications will be considered part of, or modification to, the policies and procedures as set out in this manual. Communicating With Cardholders: The Insurer’s Prerogative TELUS Health Solutions sincerely appreciates the role that the pharmacy staff plays in Diclofenac Online facilitating the smooth operation of pay direct drug plans. Thank you for helping the cardholder take advantage of the most efficient means of processing their The most frequent reasons for problems occurring at the point of service are that the cardholder information provided to us by the insurance carriers does not match that transmitted by the pharmacy or the prescribed drug is not covered by the plan. The insurance carrier is the only party capable of addressing these situations in that they maintain all cardholder eligibility records and determine all parameters for claims payment. The insurance carriers are very protective of their relationships with the plan sponsors and the cardholders. Therefore, they have asked that TELUS Health Solutions have no direct contact with the plan sponsors and/or the cardholders. The only exception is for audit purposes or to communicate the result of a request for Prior Authorization. Please do not give out the TELUS Health Solutions Assure Claims Pharmacy Support Centre phone number to the cardholder. This number is for the exclusive use of our When the problem cannot be resolved by calling the TELUS Health Solutions Assure Claims Pharmacy Support Centre, please advise the cardholder to contact their Benefits Department through the cardholder’s employer. If the issue has resulted in non-payment of the claim, your best course of action is to collect cash from the cardholder. When the problem is resolved, the cardholder can submit your receipt to the insurance carrier for reimbursement. The TELUS Assure Claims Card™ The TELUS Assure Claims Card The TELUS Assure Buy Diclofenac Claims Card will vary with respect to artwork and design depending on the insurance carrier and/or the policyholder. The common characteristics of TELUS Assure Claims Cards include the following: The Assure logo is most often present in the bottom right hand corner of the card. The Voltaren Diclofenac cardholder’s unique 20-digit ID number is shown in the middle side of the card. There will Order Diclofenac Online always be a name that appears on the line directly beneath the 20-digit ID number. This could be the name of the employee, the spouse or a dependent child. It is important to determine whether the person named on the card is the employee, or a dependent, in order to select the correct relationship code when submitting claims. In Diclofenac 75mg addition to the traditional plastic cards, some groups are opting to use paper cards for their employees. These cards may be available for employees to print from a secure website. Sample TELUS Assure Claims Card Carrier Group Certificate Issue 12 345678 0123456789 01 The Cardholder Identification Number Each cardholder is issued a unique 20-digit ID number that appears on their TELUS Assure Claims Cards and contains the The first two digits identifies the cardholder’s insurance carrier, also referred to as the carrier number The next six digits identifies the group Sodium Diclofenac or policy number The next ten digits identifies the certificate Diclofenac Voltaren number The last two digits identifies the issue number It is very important that claims be processed using the correct numbers to ensure that there are no unnecessary rejects for the cardholder when new cards are issued. The Order Diclofenac following insurance carriers and payers currently use TELUS Health Solutions to adjudicate drug claims for their clients. In the following chart, the preceding numbers represent the insurance carriers’ or payers’ identification number, also commonly referred to as the carrier identification or the carrier number. 11 Great West Life 35 Gingras 12 PSHCP 37 WSBC-BC 16 Sun Life Financial 40 Global 17 BCE Group of Companies Gel Diclofenac 44 Johnston Group 19 Reliable 49 WSIB 20 Standard Life 57 PBAS
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