Contracted pharmacies can receive more convenient access to pharmacy claims remittance advice through Prime Therapeutics' (Prime's) HIPAA compliant 835 X12N 835 version 4010A1 Electronic Remittance Advice program.

• Must be a Prime contracted pharmacy provider
• Must complete the 835 Electronic Remittance Advice request form
• Must have a secure FTP server on site to receive FTP PUSH from Prime Therapeutics.

Your secure server must be able to accept one of the following file transfer protocols:

AS2 - Encrypts the document itself in addition to encrypting the transfer using SSL. Also requires authentication (signing the message) and non-repudiation

SFTP - Utilizes SSH encryption (Secure Shell encryption protocol, a UNIX standard)

FTPS - Utilizes SSL encryption (Secure Sockets Layer encryption Protocol)

HTTPS - Utilizes SSL encryption (Secure Sockets Layer encryption Protocol)

Step 1: Complete and submit the 835 Electronic Remittance Advice request form.

Step 2: An Exhibit D-1 Payment Information will be emailed to you within three business days.

Once completed, please return the form to Prime Therapeutics for processing at the following address:

Prime Therapeutics
Attn: Network Management
PO Box 64812
St. Paul, MN 55121

Step 3: Complete Prime's Secure FTP questionnaire.

Step 4: Once Prime receives your executed Exhibit D-1 Payment Information and the completed Secure FTP questionnaire, you will be contacted by Prime's Technical staff to begin the setup and testing process.

Step 5: Allow 3 to 4 weeks for the setup process to be completed.

• Prime requires 30 days written notice for termination of the FTP connectivity.
• If you need to make changes to your existing FTP connection (IP Address), you will need to complete and send an updated Exhibit D-1 Payment Information Agreement to Prime.