Claims

Coordination of Benefits (COB) and cash paper (direct) claims

• These are claims in which PEHP is your secondary coverage and your primary carrier has already paid or you did not use your card at the pharmacy and you paid the cash price for the prescription.
• Please note that as of March 7, 2005, PEHP will no longer accept pharmacy printouts in lieu of receipts for Coordination of Benefits (COB) or direct claims. You must have your original receipts with all required information. A cash register receipt does not have the necessary information. The information needed to process these claims includes:
  1. Date the prescription was filled
  2. Name and address of pharmacy
  3. Doctor name or ID number
  4. NDC number (drug number)
  5. Name of drug and strength
  6. Quantity
  7. Days' supply
  8. Prescription number
  9. Amount paid

  This information is listed on the back of the COB/Direct claim from.
  Download Coordination of Benefits / Direct Claim Form

• You will also be required to provide the NABP or NCPDP number for the pharmacy. If this number is not listed on your receipt, a pharmacy staff member should be able to give you this number.

Pharmacy electronic claims

These claims are sent electronically from your pharmacy to Medco Health where they are processed instantly and a copay amount is determined.