New claims prescription billing

BWC's pharmacy benefits manager (PBM) asks pharmacy providers to submit prescriptions for new injuries online. Pharmacy providers need the injured worker’s Social Security number and date of injury to submit the bill to the PBM. The BWC claim number is not required. Pharmacy providers should not submit any portion of a bill for a medication used to treat a work-related injury to a private health insurance carrier.

The PBM will inform the pharmacist that this is a new claim and will return the amount BWC would reimburse for the prescription. The pharmacist can elect to collect this amount from the newly injured worker or choose to accept assignment. If the pharmacist wishes to accept assignment, the pharmacist must reverse the initial billing and re-submit the bill to the PBM with the prior authorization number 999000000.

Note: When the pharmacist accepts assignment for initial prescriptions in new claims, there is an additional dispensing fee reimbursed when the BWC claim is allowed.

In these cases, the injured worker does not have to pay, and the PBM will automatically reimburse the pharmacy once BWC allows the claim.

If the injured worker is asked to pay for the prescribed medication, the PBM will automatically reimburse him or her once BWC allows the claim.

In either case, if BWC disallows the claim, the bill becomes the injured worker's responsibility.

Pharmacy benefits program fact sheet
To learn even more about the program, click here.