January 28, 2019
Iowa Medicaid: IA Health Link Effective April 1
Effective April 1, 2016, the Iowa Department of Human Services (DHS) will be transitioning most Iowa Medicaid members to a new managed care program, calledIA Health Link. This program will be administered by three contracted managed care organizations (MCOs), Amerigroup Iowa, Inc., AmeriHealth Caritas Iowa, Inc. and United Healthcare Plan of the River Valley, Inc.
Managed Care Plan / PBMAmerigroup Iowa / Express Scripts
AmeriHealth Caritas Iowa / PerformRx
United Healthcare Plan of the River Valley / OptumRx*
*TriNet pharmacies are independently contracted with OptumRx
Express Scripts: Amerigroup Iowa
Express Scripts is the pharmacy benefits manager for Amerigroup. For Amerigroup members, submit claims to Express Scripts using the following BIN/PCN/Group combination:
BIN / 003858PCN / MA
Group / WKGA
PerformRx: AmeriHealth Caritas Iowa
PerformRx is the pharmacy benefits manager for AmeriHealth Caritas Iowa. For AmeriHealth Caritas Iowa members, submit claims using the following BIN/PCN/Group combination:
BIN / 600428PCN / 07390000
Group / varies
Express Scripts: Amerigroup Kansas
Express Scripts is the pharmacy benefits manager for Amerigroup. For Amerigroup members submit claims to Express Scripts using the following BIN/PCN/Group combination:
BIN / 003858PCN / MA
Group / WKGA
PerformRx: Blue Cross Complete of Michigan
Many regions are experiencing on-going shortages of Ventolin 90mcg HFA 8 gram and 18 gram inhalers. BC Complete of Michigan has temporarily relaxed the formulary for Proair HFA (Albuterol Sulfate) to process at the point of sale until the Ventolin shortage is resolved.
NCPDP: Action Required
NCPDP will be performing an audit of their database in the coming months. Any profiles that are no longer current will be deactivated. To keep your NCPDP number active it is required the pharmacy review and verify the pharmacy’s profile for accuracy at least twice a year. If a pharmacy profile is deactivated the pharmacy will incur a $275 charge to reactivate. TriNet recommends our members to log in as soon as possible ( and review the pharmacy’s profile. Be sure all licenses (state and DEA), hours of operations, taxonomy codes, and contact information are up to date. If you need the log in information please email NCPDP at .
Aetna: Medicare Part D Claims Processing Change
Effective April 1, 2016, BIN, PCN and Group must be submitted for all Aetna Medicare Part D Claims. Claims that are not submitted using the correct Group will result in the following or similar reject: “Reject 06: <Missing/Invalid Group ID>. Pharmacies are advised to update member profiles with the new group now in order to prevent disruption beginning April 1, 2016. The correct information for Aetna Medicare Part D claims is as follows: BIN 610502 PCN MEDDAET Group RXAETD. If a member has Medicare Advantage Plans, pharmacies should submit the claims using the following information: BIN 610502 PCN PARTBAET.
Express Scripts: Anthem Dual Eligible Part B Claims
Please ensure that all claims for Anthem Members that participate in Dual Eligible Special Needs Plan (DSNP) are submitted to the secondary Medicaid Plan. Medicaid is the payer of last resort. All other third party sources, including Medicare, are required to meet their legal obligations before a claim is submitted to Medicaid. Anthem DSNP members should have $0 cost share on Part B drugs once the remaining amount is billed to Medicaid.
MedImpact: Medica Minnesota
Effective April 4, 2016, if diagnosis codes are submitted on a claim request, the only code values that should be submitted are ICD-10 values. Per the NCPDP standard, when submitted, ICD-10 diagnosis codes should not contain a decimal point. Medica Minnesota Medicaid Members can be identified by the following information: BIN-0171472, PCN-MNPROD1, and Group-MHP20.
Caremark: Procedures for System Downtime
Caremark’s unanticipated issue that began on March 27th, 2016 has been resolved. Some pharmacies may have received a rejection as follows: Reject 56: <Non-Matched Prescriber ID>. Pharmacies are advised to assist the member and resubmit the applicable rejected claim. Once a paid claim has been captured then contact the member. If the member paid cash, please resubmit the claim and refund the member.
Page 1 of 2
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.