WebbTo join, visit our provider portal to complete the Pharmacy Network Agreement. Mail or fax the agreement along with a copy of your liability insurance declaration page, an EFT request form, and a current W-9 to: 300 TechneCenter Drive Suite B Milford, OH 45150 Attn: Provider Contracting Fax: (513) 248 3079 WebbNCPDP Version D.0 Payer Sheet Payer Name: EpiphanyRx Date: 9/21/2024 Plan Name/Group Name: ALL PLANS BIN: 020040 ... 147-U7 PHARMACY SERVICE TYPE O Prescriber Segment Segment Identification (111-AM) ... 342-HC OTHER PAYER AMOUNT PAID QUALIFIER RW Required if Other Payer Amount Paid (431- DV) ...

GuidantRX Provider

WebbOther Payer Coverage Type (COB Section) 338‐5C Primary, Secondary, etc. Other Payer ID Qualifier (COB Section) 339‐6C Ø3 ‐ BIN Number Other Payer ID (COB Section) 34Ø‐7C Primary Payer BIN Other Payer Amount Paid Count (COB Section) 341‐HB Required if Other Payer Amount Paid Webb4=Facsimile, 5=Pharmacy . Elixir Payer Sheet D.0 20-4841 . 800.361.4542 elixirsolutions.com 5 . el1x1r . 354-NX Submission Clarification Code Count 1-3 S Must be present if 42Ø -DK is used 42Ø-DK Submission Clarification Code S … mercedes amg gt s coupe

ProAct Pharmacy Services - Crunchbase Company Profile & Funding

WebbManaging more than 10m members spending over $4b in pharmacy spend. Supporting more than 5k daily users accessing. over 500k claims daily. Supporting 100k benefit designs—15k+ plans & 250+ pharmacy networks. 500M. 100K+ 500K. $4B. ProCare Rx, a Name You Can Trust. WebbPayer Specifications D.0 is also available in Portable Document Format (PDF, 580 KB, 41 pg.) EPIC, New York State Senior Prescription Plan. P.O. Box 15018. Albany, NY 12212-5018. 1-800-634-1340. This document contains the specifications of six templates: Request Claim Billing/Claim Re-bill (B1/B3) Payer Sheet Template. WebbMedical Professionals link for the payer sheets information: Commercial Primary Commercial Other Payer Patient Responsibility (OPPR) Commercial Other Payer Amount … how often rotate tylenol and motrin