SOW Pharmacy Switch Services.docx

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Healthcare Pharmacy Services

STATEMENT OF WORK

Pharmacy Claims Switching Services Purpose of work Switching Services are required when a I/T/U (Indian Health Service/Tribal/Urban) facility submits pharmaceutical claims electronically from the RPMS computer system to third party Drug Plans for reimbursement. Switching Services include: eRx Connect (switch), Edits (Pre and Post), Card Finder Web Service and Pass-Thru Fees.

Switching Services shall perform the following activities:

1. Vendor shall operate the Switching Services in accordance with the applicable Specifications.

2. Vendor shall provide facility with a local telephone number or alternative toll-free number for access on a dial-up telecommunication basis to the central processing facility for use of the healthcare services.

3. Vendor shall perform, at its election, automated data checks of the data submitted for completeness, logic and satisfaction of statistical requirements of the applicable specifications.

Indian Health Service (I/T/U) shall perform the following activities:

1. The I/T/U shall obtain an agreement with designated Drug Plans so the Switching Service can submit prescription claims for electronic adjudication and/or eligibility on behalf of the I/T/U facility transmitting claims.

2. The I/T/U will transmit Prescription claims in accordance with procedures, data element standards, formats, codes, protocols and edits set forth in the then relevant specification for such Switching Services. I/T/U acknowledges any transactions not in compliance with such requirements will be rejected.

3. I/T/U is responsible for any costs incurred in connection with modifications or enhancements to the RPMS system that are necessary for implementing the interface with the Switching Services.

4. The I/T/U will generate a purchase order to obligate funds for the Switching Services. The I/T/U will make timely payments on the invoices.

Customer Service Switching Service Customer Support will provide toll-free assistance with claims submission Monday through Friday 8:00am to 10:00pm (ET).

Fees

1. The I/T/U agrees to perform the following fees to the Switching Service, per transaction:

· eRx Connect (switch)

· eRx Edit (PPE)

· CardFinder Web Service Pass-thru fees as applicable depending on transaction origination:

· Medicare eligibility

· Web Services SureScripts

· Web Services Medicare Eligibility

2. The I/T/U agrees to pay the following fees to the MedRx Service, per transaction:

i. MedRx Medicare, Medicaid, Immunization Billing

3. These charges will be billed on a monthly basis.

4. The invoice shall identify for Prescription Claims, the Drug Plan involved, the volume of Prescription Claims and applicable total charges for the period covered by that invoice.

5. Each invoice will be due within 30 days of the date of such invoice or in accordance with the Prompt Payment Act.

6. Vendor reserves the right to suspend use of the Switching Services if past due invoices are not paid within 30 days following notice by vendor.

Pharmacy Information:

Pharmacy Name: LAWTON INDIAN HOSPITAL Contact Name: KRISTIE RIVERA Pharmacy Address: 1515 NE LAWRIE TATUM RD

LAWTON, OK 73505

Pharmacy Phone: 580-354-5537 Pharmacy Fax: 580-354-5544 Federal Tax ID Number: 73-0632862 Seven-digit NCPDP #: 3718270 NPI number: 1316097298 Pharmacy Software Vendor: RPMS (IHS) Revised 5.17.2024 4