General Questions

Workers’ compensation prescription claims have many different rules and regulations in each state. Each situation varies by claimant and injury type. ServRx™ will try to accommodate each pharmacy with circumstances that do not fall within our general guidelines. Please call our Help Desk for assistance.

No, ServRx™ verifies all claims once the prescription is adjudicated.

ServRx™ is your default processor for Workers’ Compensation prescriptions and the patient’s SSN should be entered into the cardholder ID field.

  • Call Every Time – Adjuster requests that each prescription be authorized prior to dispensing
  • Refill Too Soon – System indicates patient still has more than 25% of previous days’ supply of medication
  • Date of Injury – Date does not match DOI on file
  • Medication cost over $750

No, this could mean that the verification process has not been completed, we need more information on the claim, or there may be special restrictions on the account.

Yes, as long as this was correctly transmitted as a work- ers’ compensation claim and you received a paid label.

Missing group number. Enter SERVRX1 in the “Group” field and retransmit.

The pharmacy should call the ServRx™ Help Desk and a representative can inform the pharmacy on why they are receiving this rejection. The following are a few possible reasons why the pharmacy might receive this rejection.

  • The insurance company has requested that ServRx call on all prescriptions for this patient.
  • We have received a denial from the insurance company.
  • The information that we have received is incorrect and we have not been able to communicate with the employer or patient.

The pharmacy will receive this rejection if the drug they are processing exceeds $750. This edit is in place to make sure that the prescription is being filled correctly and to make sure that there are no outstanding payments on the claim.

The pharmacy simply needs to call the ServRx™ Help Desk. A Help Desk Representative will take the request for the Prior Authorization and our Prior Authorization department will call the insurance company. This prior authorization usually takes 48 hours. The Help Desk will call the pharmacy back to let them know what the status is on the prior authorization.

There is an edit in our system to reject any DAW 2. If you are not sure if your state’s regulations allow a DAW 2, call the ServRx Help Desk and a representative can assist you. If it is allowed they will override the edit. This edit is in place because some States will not allow brand name drug when there is a generic available.

Call the Help Desk with the required information so claim can be verified and medication approved.

Top 10 Workers’ Compensation Rejection Messages

Date of Injury transmitted for claimant is either missing or does not match date of injury ServRx™ has on file.

Some possible reasons may be: Medication is considered questionable for workers’ compensation prescriptions, claim status is inactive and needs to be re-verified, cost is over $750, medication is restricted or blocked by adjuster, etc.

System indicates that patient still has more than 25% of previous days’ supply of medication. Rejection can be overridden in special circumstances such as a dosage increase or patient leaving for an extended period of time.