Drug claims not submitted at point-of-sale must be submitted on a Universal Claim Form. The form and instructions can be found at UCF Instructions – Long Form.
The following claims filing information is specific to your facility type:
Date of service
In your monthly claims filing, the date of service for the claim should be the date the prescription was initially dispensed (month, day and year), with the format MMDDYY.
Location Code
Use Location Code (3) (in parentheses) to designate your facility as long-term care.
Usual and Customary
Claims should be filed using the pharmacy’s Usual and Customary amount (public charge). HMSA will reimburse you according to your contract rate.
Day Supply
The day supply maximum is 34 days. Do not file separate claims for the 30-day supply and additional days. The additional 4-day supply will account for EBOX fills.
Transition process
Transition Process - EOC Chapter 5, Sec 6.2 Under certain circumstances, HMSA can offer a temporary supply of a prescription drug to you when your drug is not on the Drug List or when it is restricted in some way. Doing this gives you time to talk with your provider and figure out what to do.
Here are the links to the sections for which apply to transition fills for various situations:
- HMSA Akamai Advantage® Complete (PPO) [PDF]
- HMSA Akamai Advantage Complete Plus (PPO) [PDF]
- HMSA Akamai Advantage Standard (PPO) [PDF]
- HMSA Akamai Advantage Standard Plus (PPO) [PDF]
- HMSA Akamai Advantage Dual Care (PPO SNP) [PDF]
Denied precertification requests
Either the long term care facility or the patient will be responsible for the cost of the drug.
Revision History
| Date | Nature of Revision |
|---|---|
| 08/03/2026 | Migrated to new platform. |