Effective January 1, 2016, Blue Cross Blue Shield of Alabama and Horizon Blue Cross Blue Shield of New Jersey Medicare Advantage Employer Group business will implement synchronized claims adjudication within the states of Alabama and New Jersey. This new process will allow for proper adjudication of co-administered benefits between Part D and Other Health Insurance for Employer Group Waiver plans.

There will be no operational impact to Participating Pharmacies as a result of synchronized claims adjudication. Participating Pharmacies will continue to submit pharmacy claims as they normally do today.

From a reconciliation perspective you will receive two payments that will total the full claim adjudication amount.

If you have questions regarding claims processing, please contact Prime’s Pharmacy Help Desk at 877.878.8668 for Blue Cross Blue Shield of Alabama and 800.391.1926 for Horizon Blue Cross Blue Shield of New Jersey.

Thank you,

Pharmacy