BCN announces changes to the pharmacy paid claims files in 2022

December 22, 2021

Dear BCN Medical Care Group Business Administrator:

 

Effective Jan. 1, 2022, your pharmacy paid claim files will identify if a pharmacy claim was processed by Express Scripts® or OptumRx®. Look in the claim number field.

  • Claim numbers beginning with “RXM%” were processed by ESI.
  • Claim numbers beginning with “RXO%” were processed by Optum.

The HICL field may not be initially populated for Optum claims. That field will be populated later in the first quarter of 2022. Attached is the pharmacy report layout with the HICL field highlighted.

You can expect to receive your first pharmacy paid claim file with 2022 dates of service in February.

If you have questions, please reach out to either your provider consultant or Contracting contact.