Part D boosts Rx claim rejection rate

May 22, 2006

Medicare Part D contributed to a 24% jump in the number of Rx drugclaim rejections during the first three months since the drugbenefit began, according to an analysis of claims data by WoltersKluwer Health. The Part D launch was marred by problems with claimsinvolving dual eligibles, who accounted for 64% of enrollees.

Part D boosts Rx claim rejection rate

Medicare Part D contributed to a 24% jump in the number of Rx drug claim rejections during the first three months since the drug benefit began, according to an analysis of claims data by Wolters Kluwer Health. The Part D launch was marred by problems with claims involving dual eligibles, who accounted for 64% of enrollees. The top rejection messages were "product/service not covered," "DUR reject error," and "refill too soon." The drugs most often rejected for exceeding plan limits were sleep aids, proton pump inhibitors, and erectile dysfunction drugs. The firm's white paper reviewing claims rejections, approvals, and reversals is on-line at http://www.wkhealth.com/.

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