Pharmacy reject guidance
A reject at the counter usually has a quick fix. Start here, and call the help desk if the steps below do not clear it.
[NEEDS APPROVAL — operations] Reject-by-reject guidance comes from the operations reject playbook and is published only after operations approves which scenarios are public. Until then only the general guidance below appears.
First, call while the patient is there
The fastest way to clear a reject is to call the help desk while the patient is still at the counter. A person answers and will have the procedure for that reject in front of them.
- Workers’ compensation: 844.328.2048
- Auto no-fault: 844.569.8876
Before you call
Have these ready, from the claim on your screen:
- the reject code and message exactly as returned;
- the prescription number and fill date;
- the BIN, PCN and group you submitted; and
- the patient’s employer or insurance company, if the patient knows it.
Common situations
The reject says the claim belongs to another PBM
The payer has asked for this claim to be billed through its own PBM. The reject message includes that PBM’s processing information. Resubmit to the BIN, PCN and group in the message.
The reject asks for prior authorization
Call the help desk. We will start the authorization request and keep you informed; you do not need to fax the prescriber yourself.
The reject says coverage could not be confirmed
Call the help desk with the patient’s employer or insurer and date of injury. We will try to verify the claim while the patient waits.
Reject-by-reject guidance
[NEEDS APPROVAL — operations: public subset of the reject playbook]
Per-reason pages will appear here once operations has approved which scenarios are public.