Attachment 5 - Adjudication and Recoupment Process Maps updated 6-8-2023.pdf
PDF 496 KB Posted
- Attached to
- R408--FY24 IVC PHARMACY BENEFIT MANAGER
- Solicitation number
- 36C79123R0007
About this file
This document provides two process maps detailing the adjudication and recoupment processes for a pharmacy benefit manager contract. The maps outline the steps if the Veterans Integrated Service Network 19 Value Formulary Management Program determines a recoupment from the pharmacy benefit manager is necessary due to overpayments or other issues. The recoupment process involves communicating the need for recoupment to the pharmacy benefit manager, sending automated recoupment letters in 30, 60, and 90 day increments, and withholding future payments if recoupment is not made. The related federal contract opportunity is solicitation number 36C79123R0007 for pharmacy benefit management services from the Department of Veterans Affairs Veterans Health Administration Veterans Integrated Service Network 19.
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Attachment 5 – Adjudication and Recoupment Process Maps – Adjudication Process
Attachment 5 – Adjudication and Recoupment Process Maps – Adjudication Process
Recoupment Process
VFMP
determines a recoupment is necessary
• Communicates this with Finance Management
Recoupment letters sent to
PBM
• Sent automatically in 30-60-90 day increments
If not paid, then monies are withheld from future payments
File details come from the government source that posted it. Updated .