Microsoft word - oebb dmr faq_11-03-08.doc

Direct Member Reimbursement (DMR)
Frequently Asked Questions

What is a Direct Member Reimbursement (DMR)?
At times, you may be required to submit a claim form and your receipts for reimbursement for
prescriptions filled at a retail pharmacy. This process of reimbursing is called Direct Member
Reimbursement, or DMR.
When will I need to submit a request for Direct Member Reimbursement?
As an eligible OEBB member, anytime you pay out of pocket for a prescription that is covered under
your plan, you can submit a request for reimbursement. A couple of examples are: if you have active
benefits under ODS OEBB Pharmacy Plans A, B, or C and you do not use your ODS OEBB
identification (ID) card when filling a prescription, you will need to submit a request for reimbursement; if
you go to a non-participating pharmacy that does not access ODS’ claims payment system through
MedImpact, you will also need to submit a request for reimbursement.
How do I submit a request for reimbursement under ODS OEBB Plans A, B, or C?

1. Complete the Prescription Drug Claim Form for MedImpact plans. Forms can be found online at
www.odscompanies.com, through your myODS online account or by linking directly to the forms page at
http://www.odscompanies.com/members/forms.shtml.
2. Submit claim forms to:
The ODS Companies
Attn: Pharmacy
P.O. Box 40168
Portland, OR 97240-0168
How do I submit requests for reimbursement under ODS OEBB Plan 9?
As an OEBB member, as long as you use your ODS ID card at an OPDP participating pharmacy, you
are not required to submit your receipts or a claim form to ODS for reimbursement. ODS will
automatically track expenses that may accrue toward your deductible and out-of-pocket maximum, as
well as reimburse you for eligible expenses under the prescription benefit. If you do not use your ID
card or you fill your prescriptions at a non-participating pharmacy, you will be responsible for paying the
cost of your medication and then submitting your request to ODS for reimbursement.
Follow these steps to request reimbursement:
1. Complete the Prescription Drug Claim Form for Major Medical plans. Forms can be found online at
www.odscompanies.com, through your myODS online account or by linking directly to the forms page at
http://www.odscompanies.com/members/forms.shtml.
2. Submit claim forms to:
The ODS Companies
Attn: Medical
P.O. Box 40384
Portland, OR 97240-0384

When and in what form will I be reimbursed?

ODS will process the claim request and send reimbursement to you in the form of a check. DMR claims
are processed on average within 10 business days, and checks are cut daily to ensure timely payment
to our members.
How much will I be reimbursed under ODS OEBB Plans A, B, or C?
Eligible prescription drugs purchased and paid in full by an enrollee will be reimbursed at the
ODS/ OPDP pharmacy contracted rate minus your co-payment, or the maximum plan allowance minus
your co-payment, whichever is less. Standard OEBB benefit provisions apply.
Am I required to submit the Prescription Drug Claim within a certain date span?
Yes. A claim must be submitted to ODS within 90 days after the date the medication was filled. If you
fail to furnish a claim within the time required and it was not reasonably possible to submit the claim
within those 90 days, your claim may still be valid, provided it is submitted as soon as reasonably
possible. In no event, except absence of legal capacity, is a claim valid if submitted later than one year
from the date of fill.
I’ve obtained my medication while traveling in a foreign country; do I need to translate the
receipt into English?

To ensure expeditious processing of your claims, please have your claims translated into English with
specific services, charges, drugs and dosage documented.
Who do I call if I have questions?
If you have prescription benefits under ODS OEBB Plans A, B, or C please call ODS Pharmacy
Customer Service at 503-265-2911 or toll free at 866-923-0411.
If you have prescription benefits under ODS OEBB Plan 9 please call ODS Medical Customer Service at
503-265-2909 or toll free at 866-923-0409.

Source: http://www.myods.biz/pdfs/oebb/oebb_dmr_faq.pdf