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Claims History
This information is not a complete description of benefits. Contact the plan for more information. Limitations,
copayments, and restrictions may apply. Benefits, formulary, pharmacy network, premium and/or
copayments/coinsurance may change on January 1 of each year. Magellan Rx does not display Compound Claims in
Claims History.
Rejected:
The claim was not processed due to a pharmacy submission error. Please contact your pharmacy.
Denied:
The claim was not processed due to plan coverage restrictions, or the drug is not currently covered by the plan.
This information is not a complete description of benefits. Contact the plan for more information. Limitations,
copayments, and restrictions may apply. Benefits, formulary, pharmacy network, premium and/or
copayments/coinsurance may change on January 1 of each year. Magellan Rx does not display Compound Claims in
Claims History.
Rejected:
The claim was not processed due to a pharmacy submission error. Please contact your pharmacy.
Denied:
The claim was not processed due to plan coverage restrictions, or the drug is not currently covered by the plan.
Service Date ↓ ↑ | Rx Number ↓ ↑ | Drug Name ↓ ↑ | Prescriber Name ↓ ↑ | Days Supply ↓ ↑ | Quantity ↓ ↑ | Beneficiary Paid ↓ ↑ | Claim Status ↓ ↑ | Action |
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