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For pharmacy providers billing through a third party pharmacy biller
Before you can use a third party pharmacy biller, you need to:
- Have a signed Supplemental Agreement Third Party Pharmacy Provider form (F249-021-000). This agreement:
- Allows third party pharmacy billers to route bills on the pharmacies behalf and
- Shows you agree to follow L&I rules, regulations and policies.
- Ensure the third party pharmacy biller uses the POS system.
- Review and resolve all on-line POS system edits during the dispensing episode.
- Only a licensed pharmacist can resolve POS system edits.
- Third party pharmacy billers cannot resolve POS edits.
This table shows the required entries in the Transaction Header Segment of the NCPDP 5.1 specifications when billing through a third party pharmacy biller.
| Transaction Header Segment - Required | |||
| Field name | Data element number | Required | Valid values/comments |
| Service provider ID qualifier | 202-B2 | Yes | 13 [State Issued] Other valid values are accepted but not for third party billing. |
| Service provider ID | 202-B1 | Yes | Enter 7-digit L&I dispensing pharmacy provider ID associated with the third party pharmacy biller. Other valid values are accepted but not for third party pharmacy billing. |
