Use Submission Balances to investigate At Risk and Suspended accounts subject to the applicable Submission Balances policy.
The module provides pharmacy claim submission history, purchase activity, and monthly balances to help you identify potential claim submission gaps and determine what action may be needed.
Note: This article applies specifically to Submission Balances. If you're unsure which module contains your account, refer to Where to View At-Risk and Suspended Accounts in 340B ESP.
Locate the affected account
Navigate to Submission Balances, located in the left-hand navigation menu.
Use the available filters to find the At Risk or account.
Select View Details for the affected account to open Account Details.
Review the account's submission balance
In Account Details, review the following information:
Claim submission history: The pharmacy claims submitted for the account.
Submission balances: The relationship between submitted pharmacy claims and purchases.
Monthly ledger: A breakdown of purchases, units, and net balances by month.
A negative balance indicates that submitted claims are not keeping pace with the volume of 340B purchases made through the pharmacy. If the imbalance reaches the manufacturer's applicable thresholds, the account may become At Risk or Suspended.
Use the available balance information to determine which products may require additional pharmacy claims and identify potential gaps in previous submissions.
Tip: For additional claim-level information, refer to How to Review Submitted Pharmacy Claims Data
Address the outstanding submission balance
After identifying a potential imbalance:
Review the Submitted Claims chart to identify any non-conforming claims.
Review the Submission Balance graph and Ledger to identify gaps between submitted claim units and manufacturer-reported purchases.
Determine which pharmacy claims may be missing or require correction.
Submit the applicable claims using the standard claims submission process.
Review the submission results and return to Submission Balances to check the updated balance and account status.
Confirm the applicable manufacturer submission deadline rather than assuming a universal 45-day requirement.
Note: Only conforming claims contribute positive submitted units to the ledger. Claims submitted outside the manufacturer's required submission window or that otherwise fail validation may remain non-conforming and will not address the outstanding submission balance.
Still have questions?
If you have questions or need additional help, our team is here for you — please feel free to reach out using any of the contact options below:
Chat: Available via in-app messenger
Email: [email protected]