Member Portal - Submitting claims: prescription drugs

This guide provides a step-by-step process for submitting prescription drug claims through the Member Portal, ensuring you navigate the system efficiently. It highlights essential details to include, such as the Drug Identification Number and total costs, which are crucial for accurate claim assessment. By following this guide, you can avoid common pitfalls, streamline your submission, and ensure you receive the benefits you're entitled to, making the claims process smoother and more effective.

2 minutes

Bluecross

Click **“SUBMIT A CLAIM”** from either: 1. The **“CLAIMS”** menu option, or 2. The **“Quick Actions”** section on the dashboard.

Click **"Prescription drugs"**

**Complete Claim Details 1 of 3** 1. **Are these expenses a result of a motor vehicle or workplace injury?**\ Indicate if the expenses are related to a motor vehicle or workplace injury. This helps determine if the claim needs coordination with a government program such as SGI (Saskatchewan Government Insurance) or WCB (Workers’ Compensation Board). 2. **What is the claim for?**\ The **“Drugs”** category is pre-selected based on your coverage and claim type selected in the previous screen. 3. **Is this the first time you are submitting any of the following documents for this claim: \***\ Indicate if you are including any of the following for the first time: - **Special Authorization** - **Exceptional Drug Status (EDS)** - **Special Support Program** 4. **Who is this claim for?**\ If your policy includes a partner or dependents, select the **individual who received the service or item** from the dropdown menu.

### **Complete Claim Details 2 of 3** **5. Date of Service**\ Enter the exact date the prescription was filled at the pharmacy. You’ll find this on your official prescription receipt. **6. Total Drug Cost**\ Input the **full amount charged** for the prescription, **including taxes**. This is the total cost before any insurance payments or co-payments were applied. **7. DIN**\ Enter the **Drug Identification Number (DIN)** listed on your prescription label or receipt. > *Tip:* Hover over the blue **“?”** tooltip icon for help locating and understanding the DIN. These tooltips are available throughout the portal and are there to guide you. **8. Quantity or Number of Tablets/Capsules Dispensed**\ Input the **total number of units dispensed** (e.g., tablets or capsules) as shown on your pharmacy receipt. > *This information is required to assess your claim accurately.* **9. Patient Pays**\ Enter the amount **you (patient/customer) paid** at the pharmacy for the prescription. This is often shown as **“Patient Pays”** or **“Paid by Customer”** on your receipt. **10. Has this claim been submitted to another policy or government program that you coordinate with?**\ Select **“Yes”** if this claim has also been submitted to another insurance plan (such as a spouse’s plan) or to a government program (e.g., Special Support or NIHB), even if **no amount was paid** by that other plan. You will be prompted to enter the amount covered (you may enter **$0** if nothing was reimbursed). > *Selecting “No” when you have Coordination of Benefits set up may result in your claim being **denied**, as it must be submitted to the other provider first.*

### **Complete Claim Details 3 of 3** **11. Have services on more than one date?**\ If you're submitting **multiple prescriptions or services from the same visit** for the **same plan member**, click **“+ ADD ANOTHER SERVICE FROM THIS VISIT”** to include them in one submission. Once clicked, additional fields will appear so you can enter the details for each additional claim. > *Be sure to only use this feature for services from the same visit date and for the same person.* Continue adding all applicable claims, then click **“NEXT”** to proceed once complete.

### **Select or Add a Pharmacy/Provider** **1. Choose from your recent providers**\ A list of pharmacies and providers you’ve previously submitted claims with will appear.\ If the pharmacy where your prescription was filled is listed, **select it** and click **“NEXT”** to continue. **2. Add a new health care provider**\ If the pharmacy is **not listed**, enter the provider’s details (such as name, city, and province) into the search fields and click **“SEARCH.”**\ When the correct provider appears in the search results, **select it** and then click **“NEXT”** to continue.

### **Review Pharmacy Details** Review the details for the selected pharmacy or provider to ensure they are correct. - If the information is accurate, click **“NEXT”** to continue. - If the pharmacy is incorrect or you need to make a change, click **“BACK”** to return and revise your selection.

**Update Other Insurance Coverage (if applicable)** 1. If you have other insurance coverage and need to update this information with Saskatchewan Blue Cross, complete the **Other Coverage** section. 2. Enter the **details of the other insurance provider** to update your coordination of benefits information with Saskatchewan Blue Cross. - **Name of Insurance Company:** Name of the other insurance carrier - **Member Name:** Policyholder or employee on the plan - **Date of Birth:** Policyholder’s date of birth - **Plan Number:** Policy or plan number - **ID Number:** Policyholder’s identification number - **Effective Date:** Initial date the plan began (not the benefit renewal date) - **Type of Coverage?:** Indicate if the plan is through employment, retirement, or a private plan - **Benefits:** Select all benefits held under the other plan - **Cancellation Date:** Date the coverage ended (if applicable) - **Name of Insurance Company:** If the canceled plan is different from the one listed above, provide its name After entering all relevant coordination of benefits details, click **“NEXT”** to continue.

**Submitting to a Spending Account** If you have a **group benefits plan** (e.g., through your employer) and would like to submit any **remaining eligible expenses** for reimbursement through your **Health Spending Account (HSA)** or **Wellness Spending Account (WSA),** indicate that here. > *This ensures any unpaid amounts from your claim are reviewed for potential reimbursement under your spending account.*

**Review and Submit Documents** - Once a document is attached, the system will display its **file name**, **size**, and an option to **remove** it if needed. - If you need to add more documents, repeat the previous step until all required files are attached When all necessary documents have been added, click **“SUBMIT”** to complete your claim submission.

**After you submit your claim, a confirmation message** will appear at the top of the screen stating: *“Thank you for submitting your claim.”* This confirms that your submission is complete. You’ll also receive a **confirmation email** sent to the address associated with your account.

Member Portal - Submitting claims: prescription drugs

2 minutes

Bluecross

Click **“SUBMIT A CLAIM”** from either: 1. The **“CLAIMS”** menu option, or 2. The **“Quick Actions”** section on the dashboard.

Click **"Prescription drugs"**