Claim Lookup

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Showing 1,247 claims
423 Pending 412 Processing 387 Approved 25 Denied
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Claim ID Submit Date Product Customer Claim Amount Approved Status Payment Date Actions
CLM-2024-089547 Nov 20, 2024
Lisinopril 10mg
NDC: 00071-0155-23
Regional Health System $12,450.00 $12,450.00 Paid Nov 25, 2024
CLM-2024-089546 Nov 20, 2024
Metformin 500mg
NDC: 00378-0228-01
Metro Pharmacy Chain $8,920.00 $8,920.00 Approved Pending
CLM-2024-089545 Nov 19, 2024
Atorvastatin 20mg
NDC: 00591-3775-01
Community Hospital $15,680.00 - In Review -
CLM-2024-089544 Nov 19, 2024
Omeprazole 40mg
NDC: 00186-5040-31
Specialty Care Partners $6,540.00 $4,905.00 Partial Pending
CLM-2024-089543 Nov 18, 2024
Amlodipine 5mg
NDC: 00069-1540-30
Rural Health Network $3,280.00 $0.00 Denied -
CLM-2024-089542 Nov 18, 2024
Gabapentin 300mg
NDC: 00228-2666-11
MedCity Pharmacy Chain $7,125.00 - Pending -
Showing 1-6 of 1,247 claims
...

CLM-2024-089543

Submitted Nov 18, 2024

Denied
Claim Denied - Eligibility Issue
Customer not eligible for this contract tier during the claim period. Please review eligibility requirements or file a dispute.

Claim Information

Product
Amlodipine 5mg
NDC: 00069-1540-30
Customer
Rural Health Network
DEA: EF5678901
Contract
GPO Master Agreement
CTR-2024-0142
Claim Period
Oct 1 - Oct 31, 2024

Financial Summary

Quantity 1,640 units
Unit Price $2.00
Rebate Rate 12.5%
Claimed Amount $3,280.00
Approved Amount $0.00

Processing History

Claim Denied
Nov 22, 2024 at 3:45 PM
Eligibility verification failed. Customer not on approved member list for claim period.
Under Review
Nov 20, 2024 at 9:15 AM
Claim assigned for manual review - eligibility verification.
Claim Received
Nov 18, 2024 at 2:30 PM
Claim submitted and acknowledged.