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October 2013
Are you billing correctly for these drugs?
The following drugs are often billed with incorrect quantities under the prescription drug benefit. We’ve listed the correct quantities for these drugs so your claims can be processed on time and more accurately. Please ensure that you submit the appropriate quantities on claims for all medications.
We’ve identified these drugs by their names, strength and frequently billed incorrect quantity. We’ve also listed the correct quantity that should be billed to us.
Drug name |
Incorrect billed quantity |
Correct
billed quantity |
Androgel® pump
Example: 88 g pump delivering 75 g gel |
Size of pump – 88 g |
Amount of gel – 75 g |
Premarin® vaginal cream
Example: 0.635 mg/g, 30 g tube |
42.50 g |
Actual amount of cream –
30 g |
Avonex Kit®
Example: 30 mcg/0.5 mL, four prefilled syringes |
Number of syringes – 4 |
Number of kits - 1 |
Clobex®
Example: 0.05%, 118 mL lotion |
120 mL |
Actual amount of lotion – 118 mL |
Enbrel®
Example: 50 mg/0.98 mL, four prefilled syringes |
Number of syringes – 4 |
Total Volume - 3.92 mL
(4 x 0.98 mL) |
Lovenox®
Example: 40 mg/0.4 mL, one syringe |
Number of syringes – 1 |
Volume – 0.4 mL |
Pint bottles of liquids (e.g. promethazine-codeine, etc.) |
480 mL |
473 mL |
Pregnyl® kit
Example: 10000 IU, 10mL vial |
Volume - 10 mL |
Number of kits – 1 |
For any questions on how to submit claims, contact our claims processor Express Scripts at 1-800-922-1557. For any unresolved issues or questions regarding the information in this article, contact our Pharmacy Services Clinical Help Desk at 1-800-437-3803.
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