The Rawlings Company

Pharmacy Retro-Termination Program

• The purpose of this program is to recover pharmacy claim payments made after a member or group has terminated pharmacy benefit coverage with us.
• Subsequent to verification that claims have been paid after termination, a series of letters are sent to either the former member or group notifying them of the overpayment and requesting information about new coverage.
• When the member or group contacts TRC, the new insurance information and the methods of potential reimbursement are discussed.

Note: If you receive a call from a member or a group, please stress the importance of calling TRC at the phone number listed on the letter they received. This number routes them directly to the correct person.

If they do not have the letter, ask them to call 888-846-4518. An analyst will be able to assist with any questions.

Coordination of Benefits (COB) program

• The purpose of this program is to recover claims paid when either Medicare or another health insurance company should have paid as primary.
• When other coverage is identified that should pay as primary, TRC contacts the provider, requests that they bill Medicare or the other health plan and refund the money to BCBSNC.
• In order to determine Commercial COB or Medicare primacy certain information may be needed from either the member or from the member’s employer.
• TRC may send letters and make calls to obtain this information. Members and groups can respond by mail or by phone.

Note: If you receive a call from a member or a group, stress the importance of returning the completed questionnaire to TRC. Questions about the program, please direct the person to call 888-367-7061.

Job aid

http://intraweb.bcbsnc.com/icare/Job_Aids/Customer_Service/the_rawlings_companys_investigation_and_recovery_services.html

Workers’ Compensation Program

• The purpose of this program is to recover claims paid to treat a work related accident.
• A questionnaire is mailed to the member based on specific paid claims. The member has three ways to respond to the letter: by mail, by phone or using the web.

Note: If you receive a call from a member regarding this program, please stress the importance of returning the questionnaire to TRC. Questions about the questionnaire or the program, please direct the member to call 888-285-4803.

Provider Correspondence regarding Workers' Compensation should be forwarded to Rawlings via fax to 1-502-753-7064 or via email to manualfilecoordinator@rawlingscompany.com. In order to email the correspondence, it must first be saved as pdf. Please see the CutePDF link on the TAG Self Help page. If you don't have CutePDF as an option, please contact TAG for installation.

Subrogation Program

• This program recovers claims paid for a non-work related accident where another party is liable.
• Example: When another party is responsible for the accident, their automobile insurance company is responsible for paying the claims.
• A questionnaire is mailed to the member based on specific paid claims. The member has three ways to respond to the letter: by mail, by phone or using the web.

Note: If you receive a call from a member regarding this program, please stress the importance of returning the questionnaire to TRC.

If a caller has ANY questions regarding subrogation or questions about the questionnaire, warm transfer them to Rawlings at 877-426-4178 or direct them to call Rawlings at 888-285-1616.

The Rawlings Company

By: D Best aka Angel, Bryana, Eleanor,Garrison and Rolliene