To enter a new dispensation using the Universal Claim Form (UCF), log in to PMP Clearinghouse, navigate to the UCF Submissions menu at the top of the page, and click the New Claim Form tab to begin a new submission. Multi-state data submitters will be prompted to select a PDMP from the Approved PMPs dropdown.
Enter all required details on the UCF, including patient, prescriber, dispenser, and dispensation information. Required fields will be indicated with an asterisk (*).
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Special characters are not accepted in any field. (E.g, a patient's name cannot be entered as John Peña; the name must be entered as John Pena) For questions regarding requirements for a specific field, please reference the data submission requirements established by the PDMP. |
After all required fields have been completed, or at any point during form completion, click the blue Save button to save the form. Clicking Save does not submit the data to the PDMP.
All saved (Pending) UCF submissions will be listed on the UCF Listings tab and available for review/editing on the Manage Claims Form tab.
| For more information about UCF handling and navigation, refer to Navigating & Managing Universal Claim Form Submissions. |
To submit the UCF to the PDMP, click Submit Now. A submission confirmation will present. Click OK to submit the form.
UCF data submissions will be immediately validated upon submission. If there are any issues with the submission, PMP Clearinghouse will display the number of errors in a banner at the top of the Edit UCF page and erred fields will be indicated in red.
| For more information about UCF error correction, refer to Correcting Errors on Universal Claim Form Submissions. |