Adjudicated Claims Data

Claims adjudication is a process used to pay the pharmaceutical claims submitted to a covering agency by an insured person based on benefit or coverage requirements. The adjudication process begins as an insured person presents a claim by submitting insurance identification to a pharmacy where he or she would like to pick up a prescription. The pharmacy submits this claim through a software program used to process a claim and make a coverage determination. The claim is then authorized or denied. If the claim is authorized, the pharmacist fills the prescription and is given information on any copayment the insured needs to pay for the prescription.

Pharmaceutical claims seem to be quickly processed. A prescription is presented at the pharmacy, along with a medical insurance card, ...

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