5.5 Correct Quantities Policy
General Policy Description
Pharmacies must enter claims into PharmaNet using the correct dispensed quantity to ensure the efficient and accurate adjudication of claims.
When entering a claim in PharmaNet, pharmacies are to ensure that the unit of measure used for the dispensed quantity matches that used in PharmaNet.
Using the correct unit of measure when entering a dispensed quantity will ensure accurate adjudication of claims in PharmaNet.
Claims that adjudicate incorrectly due to an inaccurate dispensed quantity are subject to recovery by PharmaCare.
Pharmacies may refer to the Correct Quantities for PharmaCare Claim Submissions list for assistance with determining the correct quantities to be entered for particular products. Pharmacies may suggest additions to this list by sending an email to email@example.com.
The PharmaCare Formulary Search may also be helpful in determining the unit of measure used for a particular product.
Pharmacies may also contact the PharmaNet Help Desk for assistance with determining correct quantities for claims.