The Claim Overview in Beacon Rebate Model provides a detailed view of an individual pharmacy or medical claim, bringing together its validation results, claim information, rebate activity, allocations, and submission history.
Accessible from the Pharmacy and Medical Reports, Accounts, and Statements modules, the Claim Overview allows you to investigate individual claims, understand their processing status, identify issues, and review associated activity throughout the rebate process.
Understanding the Claim Overview
The Claim Overview organizes information into five sections: Status, Claim Details, Rebate Details, Allocation Details, and Submission History.
Status
The Status section summarizes the claim's current validation results, rebate processing status, and quantity information.
Claim Validation Result – Most recent validation result, displayed as Conforming or Non-Conforming.
Claim Issues – Number of validation issues identified for the claim.
Rebate Status – Number of rebate payments Paid by the total number of claims submitted, which includes both Processing and Rejected claims.
Current Quantity – Number of units associated with the claim.
Remaining Quantity – Claim units remaining and available for rebate processing.
This section provides a starting point for understanding the claim's processing status and identifying issues that may require further investigation.
Claim Details
The Claim Details section displays the identifying and supporting information associated with the claim, including its claim type, covered entity 340B ID, and payment condition.
Location – Service provider or location information, including NPI and address.
Medication – Product information, including NDC, product name, and manufacturer.
Prescription – Claim information such as date of service, date prescribed, prescription identifier, and prescriber.
Insurance – Insurance information associated with the claim, including BIN and PCN when applicable.
The information displayed may vary depending on whether the claim is pharmacy or medical. Use this section to verify claim information and investigate potential validation issues.
Rebate Details
The Rebate Details section displays rebate activity associated with the claim, when available. Data will only appear under this section if a rebate is in the Processing or Paid status.
Rebate ID – Unique identifier assigned to the rebate.
Amount – Monetary value associated with the rebate.
Payment ID – Identifier associated with the rebate payment.
Status – Current processing or payment status of the rebate.
Date – Date on which the the rebate was submitted.
This section provides visibility into the rebates and payment activity associated with an individual claim.
Allocation Details
The Allocation Details section displays package and allocation information associated with the claim, when available.
Package ID – Unique identifier of the associated package.
Total Units – Total number of units associated with the package.
Remaining Units – Number of units remaining after allocations.
Date – Date associated with the allocation record.
Use this section to review package allocations and understand the remaining units associated with the claim's allocation activity.
Submission History
The Submission History section provides a record of previous submissions associated with the claim.
Submission Name – Name of the submission containing the claim.
Submitter Name – User who submitted the claim.
Quantity – Number of units associated with the claim.
Date – Date the claim was submitted.
This section allows you to review submission activity, identify previous submissions, and understand the claim's submission history. Select a linked Submission Name to navigate to the associated submission in the Accounts module.
Still have questions?
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