Scenario 3

1. An example showing the initial submission of a claim with one receipt. _PI-1 indicates "Insurance Assessment form accompanied receipt and insurance does not cover this drug."
2. An example showing the initial rejection of a claim because of non-covered extempraneous. M8-1 indicates "Yes - Mixture has been identified as an ODB Benefit"
3. An example showing the second submission of a claim with extemporaneous override. M8 indicates "Yes - Mixture has been identified as an ODB Benefit
4. An example showing the acceptance of the extemporaneous override. Approved by BPCS adjudication.
5. An example showing the third submission of a claim overriding amount
6. An example showing the acceptance of the additional overrides. EG indictes "ODB Pricing Rules applied" and EF indicates "Manual Calculation".