Final answer:
To determine the third-party claim amount for a prescription of Tetracycline, calculate 87% of AWP, compare with 100% U&C, choose the lower cost and add a dispensing fee. The final amount, in this case, is $4.78.
Step-by-step explanation:
The question involves calculating the total amount of a third-party claim for a prescription of Tetracycline 250 mg based on a reimbursement agreement.
First, we determine the Actual Wholesale Price (AWP) reimbursement by taking 87% of the AWP.
Then, we compare this amount to 100% of the Usual and Customary (U&C) cost to find which is less.
Finally, we add the dispensing fee to this amount to get the total claim amount.
Calculating AWP
AWP for 28 capsules = ($52.43 / 1000) * 28
= $1.46804.
Then, 87% of AWP = $1.46804 * 0.87
= $1.2773988.
Comparing with U&C
U&C cost is $6.99.
87% AWP is $1.2773988.
Since our agreement specifies "whichever is less", we choose $1.2773988 (87% AWP).
Adding Dispensing Fee
Total claim amount = 87% AWP + $3.50 dispensing fee
= $1.2773988 + $3.50
= $4.7773988.
Hence, the total claim amount, when rounded to the nearest cent, will be $4.78.