Pharmacy Claim Adjustments on 7/25/12 and 8/01/12 Remittance Advices (RA)

July 23, 2012

In a provider newsletter on 7/06/12, the Department has previously notified pharmacy providers that potential claim adjustments may be seen in the 7/25/12 pharmacy RA. In the previous announcement MaineCare stated:

“Some claims may have been inadvertently tagged in the financial system. To correct this issue, pharmacies will potentially see a reversal and resubmittal of these claims in question within the remittance. The reversal and resubmittal is just for internal identification of the claims and will still process as they originally paid when first submitted.”

Since that announcement, the Department has identified that the claims in question may be spread over two separate remittance cycles and appear on the 7/25/12 and/or the 8/01/12 RAs.

The claims involved are a small subset and do not include all providers.

If you have any questions, please contact GHS at 1-800-420-9711.