PACE

PROVIDER BULLETIN

September 16,  2005

 

 State Worker’s Insurance Fund

(SWIF)

 Program

 

All PACE Providers have been mailed packets of information inviting their participation as an on-line pharmacy provider in the state’s worker’s compensation program.

 

Providers enrolling in the on-line system benefit by: 

·        eliminating paper claim submission

·        knowing immediately if the prescription is covered

·        receiving payment via EFT for a covered claim within 21 days.

 

Reimbursement formula is:

·        the lesser of usual and customary charge or

·        AWP minus 10% plus a $4.00 dispensing fee or

·        Federal Upper Limits (FUL) plus a $4.00 dispensing fee.

 

SWIF claims do not have a co-pay.

SWIF is always the primary payer for worker’s compensation   claims. 

 

Please watch for the packet marked “SWIF ENROLLMENT” for more information about participating as a SWIF provider.

 

Questions concerning participation in SWIF may be directed to Provider Services at:

 

1-800-835-4080

 

PPB-05-019