The problem is when we tried to submit an MSP claim kept getting patient inelig,,see below

The card holder id is always flagged when we can see that there is something on the eligibility file that differs from what the pharmacy is sending.  ON 5/15/09 at 1:49 p.m. this pharmacy received a reject of Medicare is secondary on date of service.  With an additional message of: Bill ‘Cigna Healthcare PPOOA’ as primary and split bill Medicare w ‘SECONDARY’ in Group.  If necessary, call 877.306.7336 for pharmacy assistance.  ELIG OVER=3 will override.

In  the above instance, the card number itself was not bad but that field is flagged due to claim not being sent as a MSP claim since the eligibility file shows there is a primary insurance for that card holder.

The claim from today received a paid response due to the fact that the pharmacy did use a 3 in field 309-C9 to override the eligibility edit.  They did put SECONDARY in the group field and a 3 in the Other Coverage Code field to notate that the primary (Cigna) didn’t pay anything towards the claim.  We do have an entry for this patient that includes all primary information such as their chid with that insurance and group name/number from their primary card.  If the pharmacy had just put SECONDARY in group field and the 3 in the OCC field then the 3 eligibility override wouldn’t have been needed.

this was written by a support person at Erxnetwork.com