Third Party File Maintenance

Because over 93 percent of prescriptions are paid for with 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 chain's bottom line. For this reason, chain pharmacies need NHIN Third Party Services. NHIN Third Party Services provides a variety of useful data that enhance a chain's ability to confidently accept third party insurance for the prescriptions it fills. Currently, NHIN supports 68 insurance carriers, representing approximately 11,000 plans. NHIN adds new carriers as requested by customers, offers Enhanced State Medicaid files, and supports Canadian provincial formularies and pricing.

Paramount among the services NHIN Third Party provides is its Third Party Edits file. By implementing this file chain-wide, pharmacies can confidently fill, submit, and expect reimbursement for third party prescriptions checked against the very latest edits available in the industry. NHIN's third party edits file contains intricate pre-edit functionality that allows pharmacies to safeguard against errors, while saving time and money and ensuring maximum reimbursement from third parties.

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.