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Welcome  » February 16, 2025 6:10 AM
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Pharmacy
Alerts
  • Incorrect Claim Denials: Due to some changes that were made to the ForwardHealth system on January 1, 2025, pharmacy claims submitted on January 1 and the morning of January 2 were inappropriately denied with Explanation of Benefits code 1363 (The National Drug Code (NDC) is not on file for the Dispense Date of Service).
    The system issue is now fixed. Pharmacy providers should resubmit these claims. ForwardHealth will reprocess any non-pharmacy claims that were denied in error.
  • Part D Eligibility Issue: Some ForwardHealth members were incorrectly recorded in our system as ineligible for Medicare Part D beginning January 1, 2025. Because of this, certain pharmacy claims submitted for members with Part D were incorrectly denied by ForwardHealth.
    The system issue is now fixed. To receive full reimbursement, you will need to resubmit claims for members with Part D whose claims were denied by ForwardHealth between January 1 and January 8, 2025. Members impacted include those in the SeniorCare Level 2, Wisconsin HIV Drug Assistance Program, and Wisconsin Chronic Disease Program.

Pharmacy

Resources Supporting Coverage of Over-the-Counter Oral Contraception Under State Standing Orders

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