Tip: Pharmacy Out-of-pocket amounts





Number

0049

Submitting Entities

All entities submitting pharmacy data

Add Date

Mar 12, 2020

Update Date

 

Update

 

Description

The amount found in Member total out of pocket (PC069) has been found to be incorrect on some submitted records

Action / Resolution

Calculate Member total out of pocket instead of using PC069.  Calculation:  Sum co-pay amount (PC040), co-insurance (PC041), and deductible amounts (PC042).

Category 1

Misc

Category 2

Out-of-Pocket Cost

Tip / Issue

Tip