OhioBWC - Provider - Service: NewClaims | ||||
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Prescription billing for new claims |
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BWC expects pharmacy providers to submit bills for new injuries online through BWC's
pharmacy benefit manager (PBM), even before the injured worker has a BWC claim number. They should use the injured worker's Social Security number and date of injury.
If the pharmacist wishes to accept assignment, the pharmacist must reverse the initial billing and re-submit the bill to the PBM with the prior authorization number 999000000. If a pharmacy does not accept assignment, the injured worker is asked to pay the BWC fee schedule amount for the prescribed medication at the point of sale. The PBM will automatically reimburse the injured worker once BWC allows the claim. In either case, if BWC disallows the claim, the bill becomes the injured worker's responsibility. The use of the Outpatient Medication Invoice (C-17) for injured worker's outpatient medication reimbursement should be rare and limited to special circumstances. |
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