Mail or fax the claim to the appropriate location. When to issue prescription refund and receipt forms if the patient or representative requests one.
Insert the number of the pharmacy available from the pharmacy date dispensed and confirm receipt attached.
How to claim money back on prescriptions. On each line as required insert the dps number of each family member who paid in the month concerned. Ask the pharmacist hospital or doctor for the refund form fp57 when you pay for your prescription. The pharmacy can then run the claim for the prescription through the carrier s pharmacy claim system and provide a reimbursement for any costs that were previously paid out of pocket.
Reimbursements do not include copay amounts. Drug tariff part xvi clause 7 full details of the prescription charge refund procedure can be found in part xvi of the drug tariff. You cannot get one later.
To make a claim scan or take a photo of your receipt from the pharmacy making sure clear and doesn t cut off any details and submit it online or in the nib app. Or if the patient or representative is unsure whether they are entitled to. Receipts from your local grocery store can t be used to make a claim.
If you send all your receipts into your insurance company first they will send you back a statement that shows you in detail your total claim your total refund and therefore your total shortfall. Dps card number gms contracted pharmacy numberdispensed. Some pharmacies will allow direct reimbursements for up to 90 days but 30 is a good rule of thumb.
You will receive an answer in the mail stating whether the claim was paid denied or suspended. If the ppc holder dies their estate must be claimed within 24 months. There are time limits to claim ppc refunds so act quickly to make sure you can get back as much of your money as possible.
How can i claim a refund on a prescription charge. You must apply for a refund within 3 months of paying the prescription charge. Your receipt must include.
See the example in the notes provided on the back of this form. Your state s medicaid processing unit will review the claim to determine if you are eligible for reimbursement.