Pharmacy Benefits Eligibility Checking

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There are Surescripts Pharmacy Benefits requirements for finding a patient match. The Surecripts patient match for Pharmacy Benefits also applies for Medication History since eligibility response information is sent in the medication history request for a particular patient. 

There are five key fields that are recommended by Surescripts:

• First Name
• Last Name
• Date of Birth
• Gender
• Zip Code

Message Responses in OP

• Insufficient Information: When insufficient identifying information is sent to Surescripts to uniquely identify a patient the following message is returned "Subscriber/Insured Not Found" or "Patient Not Found". If appropriate will also send recommendations for future searches.
• Multiple Matches: When there are multiple matches found the following message is returned "Subscriber/Insured Not Found" or "Patient Not Found". If possible you will receive a list of the missing data needed to help identify an exact patient match.
• Demographic Discrepancy: When a patient match is found, but there is a discrepancy with the information found in OP, a conflict flag is shown in OP on the Pharmacy Benefits tab and a warning displayed.