Contact the KHC program for copayment information. The copay amount due is returned in the "Patient Pay Amount" field (505-F5) of the pharmacy paid claim response. Refer to the Claims Billing (B1) Transaction payer sheets for specific transaction, segment, and field requirements.

Pharmacy providers can perform an eligibility verification transaction to find the client's copayment amount. Refer to the Eligibility Verification (E1) Transaction for specific transaction, segment, field requirements, and response messages.

KHC does not issue eligibility cards. People enrolled in KHC will receive an explanation of benefits (EOB) that indicates if they are eligible for the drug benefit, but updated EOBs are not issued on a regular basis or when drug benefits change.

Contact the KHC program for questions about program eligibility. Refer to the Real-time Verification section to determine eligibility online.

Pharmacy claims must be submitted with the values identified below. Refer to the Claims Billing (B1) Transaction payer sheets for specific transaction, segment, and field requirements.