June 29, 2016
Prime Therapeutics: New Plan Announcement-Adient USA LLC
Effective July 1, 2016, Prime Therapeutics will begin processing commercial claims for Adient USA LLC. Please set up the following information prior to July 1, 2016 to guarantee
uninterrupted services for eligible members: BIN 610455 PCN AD.
Caremark: Plan Announcement-Capgemini FS
Beginning July 1, 2016, Caremark will begin to administer the prescription benefits for Capgemini FS. Please update or create member profiles to reflect the changes.
BIN / 004336PCN / ADV
Group / RX0266
Caremark: Plan Announcement-Vi
Beginning July 1, 2016, Caremark will begin to administer the prescription benefits for Vi. Please update or create member profiles to reflect the changes.
BIN / 004336PCN / ADV
Group / RX0263
MedImpact: Cincinnati Children’s Hospital
As of July 1, 2016, MedImpact Healthcare Systems will begin processing claims for Cincinnati Children’s Hospital. Please use the following information to process claims for eligible members.
BIN / 003585PCN / ASPROD1
Group / ACH02
Express Scripts: Ply Gem Industries Member ID Card
Ply Gem Industries members have a single ID card for both medical and prescription drug benefits. If your pharmacy is receiving rejections when submitting claims for eligible members under Ply Gem Industries, please be sure to enter the entire ID number show on the ID card. Include the alpha characters before the number when entering the member’s ID. Process, the claims using the following information: BIN: 003858 PCN: A4 Group: 3524RX.
Prime Therapeutics: Generic Adderall-BCBS of NC
Generic Adderall XR (amphetamine/dextroamphetamine ER capsule) will no longer be a preferred product effective July 1, 2016. Generic Adderall will require a prior authorization by BCBS of North Carolina until more manufacturers become available or the price of the drug decreases.
Express Scripts: Service Code Value
Express Scripts shows many pharmacies are submitting a high percentage of claims populated with an invalid value (usually “00”) in the Place of Service Code field (307-C7). There are a number of valid values for Place of Service Code, but “00” is not one of them. CMS maintains a list of valid Place of Service Code field values online at http://www.cms.gov/Medicare/Coding/place-of-service-codes/Place_of_Service_Code_Set.html. It is also possible the pharmacy software automatically populates this field. Please check with your software vendor to determine if this is the case.
Catamaran: Minuteman Health and Health New England
The override codes for refill too soon has changed. Please discontinue using the previous PA code. When receiving a reject 79 (refill too soon) or 88 (DUR), enter the following information into the claim: PA Type- 1 PA Code- 54321123450. This refill too soon override will allow one override per member per medication per calendar year to process. Controlled substances are excluded from this new refill too soon override process.
Express Scripts: Amerigroup Louisiana Medicaid
Effective July 1, 2016, in accordance with the Affordable Care Act, Amerigroup Louisiana will be serving additional members. Below are updates about the pharmacy benefit for these new members. If the member does not have a card please call Amerigroup at 1.800.454.3730 for eligibility verification.
BIN / 003858PCN / MA
Group / WKLA
Caremark: Georgia WellCare Health Plans
Beginning July 1, 2016, Caremark will begin rejecting claims when submitted with the NPI of an Ordering, Prescribing, and Referring (OPR) provider that is not registered as a participating Georgia Medicaid Provider. If the OPR provider is not enrolled with or does not have a Georgia Medicaid Provider ID number, he or she may enroll by completing an application at www.mmis.georgia.gov (click the Provider Enrollment link at the top of the page).
U.S. Script: Sunshine Health Plan
Centene Corporation, U.S. Script’s parent company, has acquired Health Net. Health Net delivers managed healthcare services through health plans and government-sponsored programs. There will be no change in how claims for Sunshine Health Plan claims are submitted, however beginning on July 15th, 2016, U.S. Script will transition from U.S. Script to pharmacy networks contracted and managed by Caremark. If your pharmacy is not currently contracted with Caremark, unless and until you are contracted with Caremark, your participation in the plan’s network will continue through your Participating Agreement with U.S. Script.
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