PHARMACY REIMBURSEMENT APPEAL PROCESS

ScriptClaim Systems, LLC accepts pharmacy reimbursement appeals from pharmacies that believe reimbursement for a prescription drug, medical product, or device was below the pharmacy's actual acquisition cost. Appeals are reviewed in accordance with applicable contractual and regulatory requirements.

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HOW TO SUBMIT AN APPEAL

ScriptClaim will accept the Tennessee Department of Commerce and Insurance standard appeal form. ScriptClaim may also accept other written appeal submissions that contain the required information and supporting documentation.​

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Appeals may be submitted to:

Email: appeals@script-claim.com

Phone: 800-970-5821

 

REQUIRED INFORMATION

A pharmacy submitting an appeal should provide the following information:

• Pharmacy Name
• Pharmacy NCPDP Number
• Contact Person
• Telephone Number
• Email Address
• Prescription Number
• Date of Service
• National Drug Code (NDC)
• Drug Name
• Quantity Dispensed
• Reimbursement Amount Received
• Actual Acquisition Cost
• Invoice Documentation Supporting Actual Acquisition Cost
• Wholesaler or Manufacturer Information, as Applicable
• Explanation of the Basis for the Appeal
• Any Additional Information Necessary to Review the Appeal

 

APPEAL REVIEW PROCESS

Upon receipt of an appeal, ScriptClaim will review the information provided by the pharmacy and any supporting documentation submitted in connection with the appeal.

If additional information is required, ScriptClaim will notify the pharmacy of the information needed to complete the review process.

All appeals are reviewed by personnel experienced in pharmacy claims processing, pharmacy reimbursement methodologies, and pharmacy network administration.

Appeals are tracked electronically and monitored to ensure compliance with all applicable response and determination deadlines.

 

APPEAL DEADLINES

For Tennessee pharmacies:

• Initial appeals must be submitted within seven (7) business days following submission of the claim for reimbursement.

• If an appeal submission is incomplete, ScriptClaim will notify the pharmacy within five (5) business days of receipt regarding any additional information required.

• The pharmacy will be provided five (5) business days to submit the requested information.

• ScriptClaim will issue a final determination within seven (7) business days after receipt of a complete appeal submission.

The timeline for ScriptClaim's final determination begins upon receipt of a completed appeal submission and supporting documentation.

 

NO COST TO PHARMACY

ScriptClaim does not assess any fees or costs to a pharmacy for services provided in connection with the appeal process.

 

WHOLESALER OR MANUFACTURER INFORMATION

ScriptClaim may require the name of the pharmacy's wholesaler or manufacturer, as applicable, from which the pharmacy purchased the drug, medical product, or device at issue. This information may be used as part of ScriptClaim's review of reimbursement claims and appeal determinations.

 

TENNESSEE PHARMACY APPEALS

This appeal process applies to all prescription drugs, medical products, and devices dispensed in Tennessee for which a pharmacy alleges it did not receive reimbursement equal to its actual acquisition cost. 

If ScriptClaim fails to comply with applicable Tennessee timing and notice requirements, appeals shall be administered in accordance with Tennessee law.

 

CONTACT INFORMATION

ScriptClaim Systems, LLC

Pharmacy Appeal Requests

Email: appeals@script-claim.com

Phone: 800-970-5821

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​Last Updated: June 2026