Form Phm 2 – Fill Out and Use This PDF

Form Phm 2 PDF Details

In the Commonwealth of Massachusetts, the Executive Office of Health and Human Services provides a critical resource for pharmacies and members of MassHealth through the Pharmacy 90-Day Waiver Form, known as the PHM-2 form. This document facilitates the process of requesting a 90-day extension for the submission of pharmacy claims for MassHealth members, an option available under specific circumstances detailed in the form. To ensure the request is considered, it is imperative that pharmacies fill out all sections of the form, which collects comprehensive information such as pharmacy details, MassHealth member data, and claim specifics for up to four items, including the drug name, quantity, and days' supply. Moreover, the form obliges the provider to indicate the reason for the waiver request, choosing from options such as rebilling a previously denied claim, addressing retroactive member enrollment, or rectifying retroactive provider enrollment. Understanding the importance of timely communication, the form also includes instructions for its submission, primarily via fax, to a designated number provided by Xerox State Healthcare, alongside guidelines for claims that exceed the standard submission window. Ultimately, the PHM-2 form is a vital tool in the efficient management of pharmacy claims within the Massachusetts health care system, ensuring that participants can navigate the complexities of claim submission with clarity and confidence.