Express Scripts: Reject 777 Pharmacy Alert

January 5, 2016

Express Scripts: Reject 777 Pharmacy Alert

On January 1, 2016, ESI implemented the new NCPDP Reject Code 777 (Plan’s Prescriber Data Base Not Able to Verify Active State License with Prescription Authority for Prescriber ID Submitted), in order to be more in line with NCPDP Standards.

Reject 777 results when a prescriber has an invalid taxonomy (prescription authority) for Medicare. If the pharmacist is confident the prescriber can write prescriptions for Medicare beneficiaries, he/she should reprocess the claim with a submission clarification code (SCC) value of 52 to override the reject.

If any value is submitted other than SCC 52 to override a 777 reject, the claim will reject with NCPDP Reject 8R (Submission Clarification Code Value Not Supported).

Aetna: Coventry Health Care/First Health

Effective January 1, 2016, Coventry Health Care/First Health began using new claims processing information for Medicare Part D members.

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This publication is designed to provide accurate and authoritative information in regard to the subject matter covered and is based on the most accurate information as provided to the writer. The information contained in this communication is privileged and confidential information intended only for the use of TriNet members. If the reader is not the intended recipient, please be notified that any dissemination, distribution, or copy of this communication is strictly prohibited. If you have received this communication in error, please notify us immediately.

January 5, 2016

RXBIN: 610502

RXPCN: MEDDAET

RXGRP: RXAETD

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This publication is designed to provide accurate and authoritative information in regard to the subject matter covered and is based on the most accurate information as provided to the writer. The information contained in this communication is privileged and confidential information intended only for the use of TriNet members. If the reader is not the intended recipient, please be notified that any dissemination, distribution, or copy of this communication is strictly prohibited. If you have received this communication in error, please notify us immediately.

January 5, 2016

The updated 4Rx information is required for all Medicare Part D claims. Claims not processed using this updated 4Rx information will result in a reject. When you receive rejects 01, 04, 06 and 07, check the Response Coordination of Benefits (COB)/Other Payers Segment of the claim response.

CVS/caremark will return the correct 4Rx information in the claim response when the submitted information is adequate to link to the correct 4Rx information. Use this information to update the patient profile and retransmit the claim.

Some members may have Medicare Advantage plans. Pharmacies should submit MA only claims using the following information:

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This publication is designed to provide accurate and authoritative information in regard to the subject matter covered and is based on the most accurate information as provided to the writer. The information contained in this communication is privileged and confidential information intended only for the use of TriNet members. If the reader is not the intended recipient, please be notified that any dissemination, distribution, or copy of this communication is strictly prohibited. If you have received this communication in error, please notify us immediately.

January 5, 2016

RXBIN: 610502

RXPCN: PARTBAET

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This publication is designed to provide accurate and authoritative information in regard to the subject matter covered and is based on the most accurate information as provided to the writer. The information contained in this communication is privileged and confidential information intended only for the use of TriNet members. If the reader is not the intended recipient, please be notified that any dissemination, distribution, or copy of this communication is strictly prohibited. If you have received this communication in error, please notify us immediately.

January 5, 2016

Magellan: New Medicare Part D Plan Information

Effective January 1, 2016, Magellan Rx Medicare began a new Medicare Part D Plan, Magellan Rx Medicare Basic (PDP). Pharmacies must submit claims for payment through the Magellan Rx PBM system.

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This publication is designed to provide accurate and authoritative information in regard to the subject matter covered and is based on the most accurate information as provided to the writer. The information contained in this communication is privileged and confidential information intended only for the use of TriNet members. If the reader is not the intended recipient, please be notified that any dissemination, distribution, or copy of this communication is strictly prohibited. If you have received this communication in error, please notify us immediately.

January 5, 2016

RXBIN: 018117

RXPCN: MRXMED

RXGRP: RXMRXD

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This publication is designed to provide accurate and authoritative information in regard to the subject matter covered and is based on the most accurate information as provided to the writer. The information contained in this communication is privileged and confidential information intended only for the use of TriNet members. If the reader is not the intended recipient, please be notified that any dissemination, distribution, or copy of this communication is strictly prohibited. If you have received this communication in error, please notify us immediately.

January 5, 2016

The Magellan Rx Medicare Basic (PDP) prescription drug plan is a new Medicare prescription drug plan that serves 32 states and the District of Columbia in 20 CMS prescription drug plan regions. Enrollees include both low income subsidy and non-low income subsidy members.

CVS/Caremark: Medicare Part D Information/Reminders

CVS/Caremark has released their Medicare Part D Information/ Reminders communication. The communication is available in the TriNet section of the PBA Health website. It includes the following topics:

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This publication is designed to provide accurate and authoritative information in regard to the subject matter covered and is based on the most accurate information as provided to the writer. The information contained in this communication is privileged and confidential information intended only for the use of TriNet members. If the reader is not the intended recipient, please be notified that any dissemination, distribution, or copy of this communication is strictly prohibited. If you have received this communication in error, please notify us immediately.

January 5, 2016

·  2015 Compliance/FWA Training

·  New! MAC Inquiry Enhancements

·  New! Refill Too Soon Threshold Changes

·  New! Appropriate Access and Use of the E1 Transaction

·  New! Submission Clarification Code (SCC) 49 Termination

·  Prescriber ID Requirements

·  Improving DUR Controls

·  ESRD Processing

·  Medicare Part A, Part B and Part D Drug Coverage Determinations

·  Insulin Coverage

·  Updated! Patient Residence and Pharmacy Service Type Required

·  Unique Part D 4Rx Identifier Requirements

·  Prescription Origin Code

·  Part D Vaccine Processing

·  Part D Formulary Transition Fill and Formulary Changes

·  Pro-rated Daily Cost -Share

·  Updated! Auto–Ship Refill Programs

·  Best Available Evidence (BAE)

·  Part D Marketing Guidance 2016

·  Distribution of the Standardized Pharmacy Notice (CMS-10147)

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This publication is designed to provide accurate and authoritative information in regard to the subject matter covered and is based on the most accurate information as provided to the writer. The information contained in this communication is privileged and confidential information intended only for the use of TriNet members. If the reader is not the intended recipient, please be notified that any dissemination, distribution, or copy of this communication is strictly prohibited. If you have received this communication in error, please notify us immediately.

January 5, 2016

Catamaran/ OptumRx: Wellmark Blue Cross and Blue Shield of Iowa

Effective Jan. 1, 2016, UnitedHealthcare began administering the prescription benefits for hawk-i program members that were previously Wellmark Blue Cross and Blue Shield of Iowa members. Please update or create plan member profiles to reflect the changes regarding the following new plan adjudicating through OptumRx:

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This publication is designed to provide accurate and authoritative information in regard to the subject matter covered and is based on the most accurate information as provided to the writer. The information contained in this communication is privileged and confidential information intended only for the use of TriNet members. If the reader is not the intended recipient, please be notified that any dissemination, distribution, or copy of this communication is strictly prohibited. If you have received this communication in error, please notify us immediately.

January 5, 2016

RxBIN: 610494

RxPCN: 9999

RxGrp: hawki

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This publication is designed to provide accurate and authoritative information in regard to the subject matter covered and is based on the most accurate information as provided to the writer. The information contained in this communication is privileged and confidential information intended only for the use of TriNet members. If the reader is not the intended recipient, please be notified that any dissemination, distribution, or copy of this communication is strictly prohibited. If you have received this communication in error, please notify us immediately.

January 5, 2016

Wellmark Blue Cross and Blue Shield of Iowa members carry cards similar cards and may not have their new coverage card, please use their Hawk I ID number (9 digits beginning with H) when submitting claims.

CVS/Caremark: Member ID Submission Clarification, Elderplan

Effective January 1, 2016, CVS/caremark will began administering the prescription benefits for Elderplan. Elderplan members were issued ID cards that show only 9 digits. In order for claims to process, the member’s full ID must be submitted with 11 digits. Please submit the 9 digits from the ID card with “01” appended on the end to meet the full 11-digit requirement (Member ID Format: 9 digits + “01”). This affects members in the MAPD and FIDA products.

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This publication is designed to provide accurate and authoritative information in regard to the subject matter covered and is based on the most accurate information as provided to the writer. The information contained in this communication is privileged and confidential information intended only for the use of TriNet members. If the reader is not the intended recipient, please be notified that any dissemination, distribution, or copy of this communication is strictly prohibited. If you have received this communication in error, please notify us immediately.

January 5, 2016

RXBIN: 004336

RXPCN: MEDDADV

RXGRP: RX8585 (MAPD), RX8587 (FIDA)

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This publication is designed to provide accurate and authoritative information in regard to the subject matter covered and is based on the most accurate information as provided to the writer. The information contained in this communication is privileged and confidential information intended only for the use of TriNet members. If the reader is not the intended recipient, please be notified that any dissemination, distribution, or copy of this communication is strictly prohibited. If you have received this communication in error, please notify us immediately.

January 5, 2016

Prime Therapeutics: ABCBS Part D ID Number Update

As of January 1, 2016, Participating Pharmacies are no longer required to enter the alpha characters for Medicare Part D Covered Persons of Arkansas BlueCross and BlueShield (ABCBS)

ID numbers. Covered Persons will be receiving new ID cards and have been instructed to present their new card when filling a prescription at a Participating Pharmacy.

Claims must only be submitted using the nine-digit numerical ID number, excluding the leading alpha characters.

For example:

Enrollee ID listed on Card: XCX918888888

Submit Enrollee ID as: 918888888

Prime Therapeutics: BCBSTX STAR and CHIP

Effective 12/1/2015, Prime Therapeutics (Prime) began processing pharmacy claims for eligible BCBSTX STAR and CHIP Covered Persons. To ensure uninterrupted service to participating pharmacies and covered persons, please use the following billing information when processing claims:

*TXS1, TXS2; TXC1-7

Navitus: FirstCare Health Plan

Effective January 1, 2016, Navitus Health Solutions began processing claims for FirstCare Health Plan Commercial, Self-Funded, Exchange and Medicare lines. This client has members in Texas. There are no changes to the current Medicaid processing information.

30-day and 90-day supply allowed (limited products)

PBA Health Website

BIN/PCN/Group Combination Chart for plans (new and updated) effective January 1, 2016 is available in the TriNet section of pbahealth.com

To access this chart and other Medicare Part D helpful resources, log in to the pbahealth.com. After you log in, choose “TriNet”, then “Resources.” Choose the “Key Terms” category. Finally, choose “Medicare Part D.”

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This publication is designed to provide accurate and authoritative information in regard to the subject matter covered and is based on the most accurate information as provided to the writer. The information contained in this communication is privileged and confidential information intended only for the use of TriNet members. If the reader is not the intended recipient, please be notified that any dissemination, distribution, or copy of this communication is strictly prohibited. If you have received this communication in error, please notify us immediately.