Pacific Blue Cross Manual Claims

PharmaClik Rx can generate Pacific Blue Cross manual claim forms - on the pharmacy’s behalf - for online claims that receive an A6 (Submit Manual Claim) rejection.

To create a Pacific Blue Cross manual claim:

1. The rejected Pacific Blue Cross claim is displayed in the Third Party tab of Rx Detail. The rejection indicates A6 SUBMIT MANUAL CLAIM. The claim response message may indicate why the prescription requires a manual claim.
2. Press the More Info button to view the claim response message.
3. Press the Fill button.

The claim becomes Complete and PharmaClik Rx creates an offline claim for Pacific Blue Cross. The Patient Pays amount on the receipt indicates $0.00, unless a Pacific Blue Cross deductible has been set in the patient’s Third Party tab (the deductible will be indicated instead).

The pharmacy will receive the Pacific Blue Cross manual claim forms in the following week’s production package from PharmaClik Rx. These forms are carbonized invoices that must be signed and manually submitted to the third party for reimbursement. If you do not sign and submit these forms to Pacific Blue Cross, the pharmacy will be NOT paid for the prescriptions.

Note: You can press the Abort or Skip TP button in the Rx Detail Third Party tab if you DO NOT want to create a manual claim for the prescription. The patient’s receipt will print with the appropriate Patient Pays amount. This amount should be collected from the patient; the patient can submit his/her own manual claim.