Reversing a Claim That Is Too Old

PharmaClik Rx allows manual reversals to be created for online claim reversals that are returned from the third party as REVERSAL REJECTED. Manual Reversals will be available for claims that are rejected with any of the following CPhA response codes:

• A1 - Claim is too old
• A7 - Submit manual reversal
• A9 - Reversal processed previously

When the First Third Party in the Reversal is Rejected

When the first third party in the reversal is rejected because the claim is too old, PharmaClik Rx provides the ability to abort the reversal request.

Therefore, when a claim is too old to be reversed online, and the claim is the first third party in the billing code to be reversed, a prompt will appear. The 2-character billing code for the third party will be shown in the message.

Pressing Yes will perform a manual reversal for the third party indicated in the message; the claim status for that third party will become Cancelled. An online reversal will be sent to the remaining online third parties in the prescription’s billing code.

Note: If required by the third party, you must submit a paper claim for the manual reversal.

Pressing No will NOT reverse the prescription; the screen will return to the Third Party tab in Rx Detail and the prescription will have the claim status Reversal Rejected. At this point you have several options:

• Pressing the Abort button will abort the reversal request. The prescription will be stored with the same status it had before the reversal was attempted.
• Pressing the Save button will save the prescription in the Queue. The prescription will still have the claim status Reversal Rejected. This allows you to store the prescription in its current state and deal with it at a later time.
• Press the Correct button to either submit a manual reversal or attempt refuse the prescription again.

When One Third Party is Successfully Reversed and Another Third Party is Reversal Rejected

In a situation where one third party in the billing code has been successfully reversed and the next third party cannot be reversed online, PharmaClik Rx will mark the rejected claim as a manual reversal and continue to reverse any remaining third parties online.

A message will indicate that the claim cannot be reversed online. Press OK in the message. A manual reversal will be performed for the third party indicated in the message; the claim status for that third party will become Cancelled. An online reversal will be sent to the remaining online third parties in the prescription’s billing code.

Note: If required by the third party, you must submit a paper claim for the manual reversal.