13. Insurance Processor File
Insurance Processor File
The Insurance Processor (also referred to as Processor/PBM) is a key component in insurance claim routing within BestRx.
It is not a standalone file, but rather a set of data fields and mappings primarily stored in:
Insurance Plan File (F5)
Master Insurance File
The processor determines how claims are routed and how responses are returned during adjudication.
To access the Insurance Processor File, go to File 13. Insurance Processor File.
Edit Clawback
Clawback Type can be edited for an individual plan by selecting the pencil icon, or you can select Edit Clawback to update the Clawback Type for the processor and all individual plans associated with that processor.
Brand Clawback Type: DIR Fee or BER (Brand Effective Rate)
Generic Clawback Type: DIR Fee or GER (Generic Effective Rate)
Values will be reflected as percentages (%).