After how many days do you have to reverse and RTS a retail claim if it hasn't been picked up?

[justjoe]

Is there a standard? What is the most common with insurance companies?

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[SouthernRetailRPH]

standard at most places is 14 days or less

 

[zelman]

Insurance companies will not typically lock claims that are less than 4 weeks old, so anything under that should be fine.

 

[Dred Pirate]

Company policy is usually 7-14, but from my experience in a past life it was around 30

 

[Thankyou2017]

Insurance companies will not typically lock claims that are less than 4 weeks old, so anything under that should be fine.

Rite Aid CBT Computer Based Training showed me once in the past some concept like this:
Day 1 of billing, we get paid and we have legal contract that if patient does not pickup in 15 days, we reverse payment.
Policy is: Computer prints every morning showing list of scripts done for 13 days already.
We have seen many stores forget to delete on day number 13 and therefore the report of next morning shows scripts done for 13 days and 14 days. We then have this chance to delete. (We understand mistakes happen or power outage, tornado, fires, flood happened, then we have this chance to try to delete.)

District emails to pharmacists shows stores that have scripts done 15 days or more already. This give us clues that we are legally okay with scripts waiting 14 days but we will be in trouble for scripts waiting 15 days.

Please correct me if I am wrong because I don't have the clear memory of that training.

 

[sosoo]

at cvs u can have day 30 or 60 or infinity. i have seen stores like that and no one really care.

 

[CynicalIntern]

at cvs u can have day 30 or 60 or infinity. i have seen stores like that and no one really care.

You're really doubling down this week, aren't you? We started with dispensing adulterated product, and now we've moved onto insurance fraud!

 

[owlegrad]

Hmm I seem to recall that after 28 days the scripts fall off the RTS report at CVS. True/false?

 

[zelman]

Hmm I seem to recall that after 28 days the scripts fall off the RTS report at CVS. True/false?

They do disappear around then. Corporate just reverses the claim at some point.

 

[RxPreceptor]

By day 14, or by day 7 for new scripts that are NOT new maintenance meds to the patient (day 7 go backs: acute med, cashed out, ridiculous copays, etc.)

 

[Construct105]

Every 14 days seems to be pretty standard. No reason to hold it any longer unless the pt has notified someone that they want it to be kept longer.

 

[maria1oh]

I was at a cvs once that never cared about will call. When a waiting bin got too full they would dig for old prescriptions to take out and delete to make room for the new ones.