Application

BLUE CROSS®, BLUE SHIELD® and the Cross and Shield Symbols are registered marks of the Blue Cross and Blue Shield Association, an association of independent Blue Cross and Blue Shield Plans. Blue Cross NC is an independent licensee of the Blue Cross and Blue Shield Association. InComm Payments is an independent company providing health and wellness card services on behalf of Blue Cross NC.

Please complete the following application that will be used to generate your contract.

If you need help completing this form, please contact our Sales and Support Team at 877-535-4707 EST during normal business hours for assistance.

BUSINESS INFORMATION
All fields with an * asterisk are required and must be completed to submit the application. 

Name company is registered with the state

Business Name on the building

ex: 111-111-1111

ex: 111-111-1111

Mobile Phone number is required to receive a one-time password once the Terminal or Web Access is received. 

ex: 111-111-1111

This is used to configure terminal for transaction purposes.
TERMINAL DEVICE OPTIONS (SELECT ONE) 


BUSINESS ADDRESS INFORMATION


ex: 123 SW Main Street

ex: Suite, Building




BUSINESS BILLING INFORMATION

ex: 123 SW Main Street

ex: Suite, Building




ex: 111-11-1111
PRINCIPAL INFORMATION
Note: All Principal information is required and should include the business owner's personal information only




ex: 111-111-1111



ex: 123 SW Main Street

ex: Suite; Building



COMPANY INFORMATION



STATE ID/ TAX BUSINESS REGISTRATION INFORMATION




If applicable

If applicable

PROGRAM INTEREST 

ADDITIONAL INFORMATION






Eligible Products

Allergy/Cold/Sinus/Pain Relief

Antihistamines, adult cough, cold and flu, adult pain relief, allergy and sinus medications, decongestants, symptom relief, expectorants, nasal and sinus, cough drops, anti-inflammatories, anti-arthritics, fever reducers

Dental & Oral Health

Denture products, interdental, gum care, etc.; toothbrushes, toothpaste, floss, mouth sore products

Diabetes Care

Diabetes care accessories, diagnostic products, foot treatments, skin care, external pain relief, supplements

Digestive Health

Acid controllers, anti-gas, anti-diarrhea, digestive aids, laxatives, lactose intolerance products, hemorrhoidal preparations, stomach remedies

Eye and Ear Care

Contact lens care, ear care, eye preparations, hearing aids, hearing aid batteries, reading glasses, magnifying glasses, eye drops, ear wax removal

First Aid

First aid dressings, first aid kits and supplies, first aid treatments, adhesive bandages, hot/cold gel packs, digital thermometer, ice bag, liquids (alcohol and peroxide in first aid), antibiotic ointment

Foot Care

Antibiotic creams, antifungal, corn and callus, compression

Home Care & Daily Living

Bathroom safety items, grab bars, elevated toilet seat, pill boxes, reacher/grabber aids, telephone aids, night lights

Incontinence

Incontinence supplies, protective underwear, fitted briefs, pads, rash ointments and rash creams

Skin Care

Anti-itch medications, anti-parasitic treatments, lip care (medicated), sun protection (SPF 15+), acne treatments, dermatitis, eczema, psoriasis, rash, warts, lice, worms, scabies, calluses, wound care (specialized)

Smoking Cessation

Nicotine replacement patches/gum

Supports, Bands & Wraps

Abdominal supports, orthopedic and surgical supports, ankle, knee and wrist supports, medical support (high compression), low compression hose

Questions about covered items? 

Email InComm Payments at IndyOperations@incomm.com

If you would like to speak with a team member, please call 877-535-4707 for assistance. 

FAQ’s

What are the benefits of accepting the OTC Network card?

When members use their OTC Network cards at your location, you receive full payment for their qualified purchases. Each member is credited a specified dollar amount, which is loaded to their card each month and can be spent on thousands of over-the-counter health-related products.

We have over four million cardholders across our Medicare Advantage programs, each receiving $25-$120 per month, and Medicaid receiving an earned reward amount, through their plan. By accepting the OTC Network card, you are providing an important service to your customers as a local destination for these purchases. You can also help boost your sales and promote repeat visits to your location by joining the network.

 

How does it work?

InComm provides you with a standalone USB scanner and card reader for processing OTC Network payments. After a customer’s items have been rung up at the register, they will swipe their OTC Network card on our device. All eligible purchases will be deducted from their total based on available OTC Network credits, and we will reimburse you for those items. The customer will pay their remaining balance through your system.

Retailers are reimbursed 14 days after their first transaction; thereafter, you will receive daily invoices and payment.

What is the cost?

There is no cost for the OTC card reader. Blue Cross and Blue Shield of North Carolina (Blue Cross NC) will purchase the InComm Payments OTC Network Card Processing System equipment – normally $250 – so there will be no cost for independent pharmacies in North Carolina. The following additional fees will still apply:

  • 2.5% transactional processing fee, applicable to all eligible OTC items purchased at each retail store location during the prior billing period 
  • $1.00 adjudication fee per purchase transaction (per basket, not per individual item)

Can the card be used online or by phone for catalog purchases?

No. The OTC Network card can only be used for in-store purchases. This helps ensure more traffic to your store.

What products are covered?

Thousands of name brand and generic products are covered, including many items with an MSRP between $15–$65. Examples of eligible items include over-the-counter health products such as bandages, pain medicines, diabetes supplies, and cold and flu treatments, as well as hearing aid batteries, smoking cessation products, dental products and incontinence supplies.

 

Our top five product categories are:

  • Cold and allergy 
  • Eye and ear Care 
  • Digestive health 
  • Home diagnostic and patient aids for daily living 
  • Smoking deterrents 

What do I need to get started?

Complete our online application form. Once your application is submitted, someone from our team will contact you. You’ll need the following information to complete the application:

  • Federal Tax Identification Number/EIN 
  • Tax/business registration information including your SIC Code and Dun & Bradstreet (D-U-N-S®) number 
  • Your pharmacy’s National Provider Identifier (NPI Number)

Why do I need to provide my National Provider Identifier (NPI Number)?

InComm requires these numbers to complete background checks and inquire about state exclusions. We are legally required to perform this action on a regular basis to ensure every merchant in our network remains in good standing.

How does InComm qualify me for approval?

InComm runs background and credit checks on each applicant. The applicant must meet basic credit requirements and pass a criminal history and background check.

What kinds of network capabilities do I need?

The equipment is a standalone device and does not integrate with a customer’s existing POS system. At this time, we do not support DSL.

Questions about covered items?

Email InComm at IndyOperations@incomm.com.

Interactive Communications International, Inc., its subsidiaries, and affiliates (collectively “InCommPayments”) are committed to providing a superior digital experience for our consumers and our business customers, and we are particularly concerned about making our websites accessible to individuals with disabilities. For the best online experience, InComm Payments recommends that your technology be kept up to date: Use the latest version of your web browser; and use the latest version of your assistive technology Technical Assistance in the event that an individual with a disability experiences technical difficulties in accessing an InComm Payments website, please call us at 1-833-345-5232 or send an email to ADA_Support@incomm.com. In your communication to us, please specify the nature of the technical difficulty, including the website URL that has presented an accessibility challenge. Requests for accommodations for individuals who need to request a reasonable accommodation under the U.S. Americans with Disabilities Act of 1990 to access product, services, information or materials on an InComm Payments website, please call us at 1-833-345-5232 or send an email to ADA_Support@incomm.com. Please describe the accommodation requested and include your contact information (such as an email address and/or telephone number). Depending on the nature of the request, InComm may need sufficient advance notice to provide a reasonable accommodation. Third-party and InComm Payment’s websites may contain links to webpages hosted by third parties. Unfortunately, InComm Payments cannot make any representations with regard to the accessibility of third-party websites and is unable to remediate accessibility barriers on such websites if they exist. We are always working to ensure that our products, services, information, and materials are accessible to all our business customers and consumers, including individuals with disabilities. If you have an idea to improve accessibility or a question about accessibility support, please contact us at 1-833-345-5232 or ADA_Support@incomm.com. We welcome your feedback.