Procella HelpdeskPricing Claim History
Pricing requests directly hits the Web-API layer of the Procella platform. The pricing requests are also processed as standard claims (claims from pharmacy). The difference in pricing requests processing is, that it skips some validations in Transaction Engine processing and the claim data is stored only in pricing_adjudication_audit table.
Standard claims (Pharmacy claims & API claims) can be viewed in Customer Services -> Claim History screen
Test Claims (Claims processed as test claims from Claim submission tool
| Claim Type | About Claims | Claims can be viewed in |
| Standard Claims | Standard claims are claims received from the pharmacy, claims that are sent through Relay Health or through API. Manual claims submitted through the claim submission tool from procella platform. | Customer Services -> Claim History screen (Standard) |
| Test Claims | Test Claims are claims submitted from Procella Platform through Claim submission tool | Customer Services -> Claim History screen (Test Claims) |
| Pricing Claims | Price check requests that are received from an external system through API Price check submitted from Procella platform through Price check option | Customer Services -> Pricing Claim History |
Customer Services -> Claim history (Standard Claims)
Customer Services -> Claim History (Test Claims)
Customer Services -> Pricing Claim History
The pricing claim history list screen displays the following data
- Claim data
- Finances data
- Drug
- Provider and Provider Network data
Pricing Check Feature
- This testing feature can be used if the PBM user wants to check the drug pricing of a certain benefit group
- Click on the Check Price link in the Pricing Claim History filter.
- The form has the following data's
| Field | Mandatory / Optional | Description |
| BIN | Optional | |
| PCN | Optional | |
| NPI | Mandatory | |
| NDC | Mandatory | |
| Group ID | Mandatory | User has to select the group from the dropdown |
| Quantity | Mandatory | 30 will be default quantity prefilled in the form |
| Day Supply | Mandatory | 30 will be the default days supply prefilled in the form |
| U&C | Optional | If value is not provided, value will be defaulted to 999999999.99 |
- NPI (Service Provider ID) , NDC and Group ID are required to get pricing data
- Fill in the mandatory details, click on the Check Price button to see the Patient Pay Amount. The request will be processed and the patient pay amount will be displayed
- The patient Pay amount will be displayed on the top along with the submitted data
- If the system is unable to find Price, then the reject message is displayed as below
- Click on Close button to view the claim data summary in the list screen