Online Adjudication System definition
Examples of Online Adjudication System in a sentence
Sponsor is further responsible for providing, at its own expense, any hardware and/or software that may be necessary to effectuate access to the Online Adjudication System, and for paying all telecommunication access fees.
PBM shall load electronically submitted Member data into the Online Adjudication System no later than twenty-four (24) hours from receipt of such data.
Sponsor (or its agents) shall have the right to access the Online Adjudication System for adding or updating patient eligibility, and for creating real-time prior authorization approvals or prescription claim overrides.
Sponsor may not deny claims submitted by any Participating Pharmacy for payment subsequent to such Participating Pharmacy receiving approval via the Online Adjudication System.
Eligibility information submitted on hard copy requiring data input will be loaded into the Online Adjudication System no later than seven (7) days from receipt of such data.
Sponsor is solely responsible for the accuracy, completeness, reliability, and timeliness of all information it enters into the Online Adjudication System.
Through the Online Adjudication System, Sponsor has the ability to add, update, and terminate patient eligibility; create real-time prior authorization approvals; track progress of adjudicated pharmacy claims; and review data submission in PBM’s file library system.