Supplemental Agreement 3rd Party Pharmacy
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5Instructions for
Return To:
Department of Labor and Industries
SUPPLEMENTAL AGREEMENT
Provider Accounts
PO Box 44261
THIRD PARTY PHARMACY
Olympia WA 98504-4261
PROVIDER
(360) 902-5140
FAX (360) 902-4484
DEFINITIONS:
“Pharmacy” shall mean a qualified institution with a valid NCPDP and/or NPI number that has
been issued a provider number by the department to furnish prescription services to injured
workers.
“Third-Party Pharmacy Biller” is the term used to describe an entity that submits pharmacy
bills on behalf of the associated pharmacy or has purchased pharmacy bills from the dispensing
pharmacy for subsequent submission to the department’s Medical Information Payment System
(MIPS) for payment.
“Pharmacy Point of Service (POS)” is the term used to identify the real-time pharmacy bill
processing system that finalizes most prescription bills at the point of entry as either paid or
denied.
PURPOSE:
The purpose of this agreement is to define access, performance and legal requirements for Third
Party Pharmacy Billers submitting pharmacy bills to and receiving payment from the
Department of Labor and Industries (L&I) State Fund on behalf of the pharmacy providers for
prescription services provided to injured workers pursuant to the Industrial Insurance Act. This
agreement is also to authorize the department to accept and remit any monies due the Pharmacy
for the billed prescription services to the Third Party Pharmacy Biller.
PROVISIONS:
1. The POS system adjudicates and notifies the dispensing pharmacy, through POS edits, of
several potential drug therapy issues including potential high dose, therapeutic
duplication, drug to drug interactions, refill too soon, prescriber endorsement status,
therapeutic interchange requirements and many other administrative edits. All edit issues
must be resolved prior to dispensing the medication to the injured worker.
2. All edits must be resolved in real time by the dispensing pharmacy prior to dispensing the
medication to the injured worker.
3. Pharmacies may submit bills for prescriptions for all open and allowed State Fund
claims. The dispensing pharmacies can also submit bills for workers who pay for their
prescriptions when their claims have not been initiated. L&I reimburses the worker after
the claim has been allowed and the prescription authorized.
4. All pharmacy bills associated with Third Party Pharmacy Billers must be electronically
submitted through the POS system.
F249-021-000 supplemental agreement third party pharmacy provider 03-2007
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