Third Party File Maintenance

With over 93 percent of prescriptions paid for by commercial third party insurance, Medicaid, or filed under a Medicare Part D plan1, an up-to-date third party edits file is vital to a retail pharmacy’s bottom line. For this reason, pharmacies need NHIN Third Party Services.

NHIN Third Party Services provides a variety of useful data that enhance a pharmacy’s ability to confidently accept third party insurance for the prescriptions it fills. Currently, NHIN supports numerous insurance carriers, representing a wide range of plans. NHIN adds new carriers as requested by customers.

Pre-editing and verification of online carriers reduce transmission and labor costs—an especially valuable feature when a carrier is experiencing downtime. Edits are set up by using therapeutic restrictions, which allow NHIN to define restrictions for a range of drugs without creating a separate drug third party record for each NDC.

Each week, NHIN downloads the most current third party edits data to subscribers. These downloads contain all adds, updates, and deletions made over the previous seven days. A comprehensive file is also available on a weekly basis. NHIN Third Party Services also offers carrier code conversions for new customers and provides new carrier codes on request.

For more information, contact or call 1-800-433-5719.