January 13, 2006
State Worker’s Insurance Fund
This Bulletin is to clarify the recent PACE/PACENET/SWIF communication you may have received regarding the processing of pharmacy claims for workers’ compensation injured workers.
The Pennsylvania State Workers’ Insurance Fund has integrated its pharmacy claims adjudication system with the PACE Program’s on-line claim’s processing system.
First Health Services is responsible for the adjudication of PACE/PACENET claims.
The SWIF program is solely for workers covered by SWIF and participation is voluntary by Pennsylvania pharmacy providers. Participation in this program requires the pharmacy participant to submit claims on-line to SWIF and reconcile the remittance based upon EOB’s received with SWIF payment. Cardholder eligibility may be verified either systematically via the Program’s eligibility transaction or by calling Provider Services toll-free at 1-800-835-4080. All other non-SWIF worker’s compensation pharmacy claims should be dispensed and adjudicated by you through any current arrangements you may have with other agents or assignees and in accordance with the Pennsylvania Department of Labor and Industry regulations.
Should you have any questions regarding the processing of workers’ compensation claims for SWIF claimants, please contact the SWIF provider toll-free number of 1-800-835-4080.
Any questions regarding a cardholder’s eligibility or drug coverage should be addressed to:
State Workers' Insurance
100 Lackawanna Avenue
P.O. Box 5100
Scranton, PA 18505-5100
For all other workers’ compensation claims, you should contact your current agent or assignee.