The Pharmacy Support Center is available to answer provider claim submission and basic drug coverage questions. Medicaid 010900 8263342243 VAMEDICAID CCC Plus Health Plans RxBIN RxPCN RxGRP Aetna Better Health of VA 1-866-386-7882 610591 ADV RX8837 Anthem HealthKeepers 1-855-323-4687 020107 FM WQWA Magellan Complete Care 1-800-424-4524 016523 62282 VAMLTSS Optima Family Care 1-866-244-9113 610011 OHPMCAID N/A UnitedHealthcare 1-855-873-3493 OptumRx Part-D and MAPD Plans BIN: 610097 PCN: 9999 Part-D WRAP Plans BIN: 610097 PCN: 8888 PCN: 8500 OptumRx (This represents former informedRx) BIN: 610593 PCN: HNEMEDD PHPMEDD PCN: SXCFLH . Clinical concerns or PDP questions should be directed to (877)3099493 or visit the. All Health First Colorado providers are required to use tamper-resistant prescription pads for written prescriptions. Disclaimer for Chronic Condition Special Needs Plan (SNP): This plan is available to anyone with Medicare who has been diagnosed with the plan specific Chronic Condition. Drugs manufactured by pharmaceutical companies not participating in the Colorado Medicaid Drug Rebate Program. The Michigan Domestic & Sexual Violence Prevention and Treatment Board administers state and federal funding for domestic violence shelters and advocacy services, develops and recommends policy, and develops and provides technical assistance and training. Required if this field is reporting a contractually agreed upon payment. This form or a prior authorization used by a health plan may be used. 04 = Amount Exceeding Periodic Benefit Maximum (520-FK) Effective 10/22/2021, Updated policy for Quantity Limit overrides in COVID-19 section. Claims that cannot be submitted through the vendor must be submitted on paper. If a member requires a refill before 50% of the day supply has lapsed, please provide the Pharmacy Support Center details of the extenuating circumstances. Appeals to the Office of Administrative Courts must be filed in writing within 60 days from the mailing date of the reconsideration denial. Pharmacies that are not enrolled in the FFS program as billing providers must enroll, in order to continue to serve Medicaid Managed Care members. Plan Name/Group Name: Illinois Medicaid BIN: 1784 PCN: ILPOP Processor: Change Healthcare (CHC) Effective as of: September 21, 22 NCPDP Telecommunication Standard Version/Release #: D. NCPDP Data Dictionary Version Date: July 27 NCPDP External Code List Version Date: July 213 Contact/Information Source: 1-877-782-5565 Health plans usually only cover drugs (brand and generic) that are on this "preferred" list. Services cannot be withheld if the member is unable to pay the co-pay. This webpageis designed toprovide easy access for members and providers looking for information on the drugs and supplies covered by Michigan Medicaid Health Plans. The individual managed care entities (MCEs) serving Healthy Indiana Plan (HIP), Hoosier Care Connect and Hoosier Healthwise members contract with designated pharmacy benefit managers (PBMs) to manage the pharmacy benefits and process pharmacy claims for their enrolled members under the IHCP managed care delivery system. All member ID numbers will be the same for the beneficiary whether they are enrolled in a health plan or in NC Medicaid Direct. For TXIX, if the prescriber confirms that the drug was not prescribed in relation to a family planning visit, then the pharmacy should remove the 6-Family Plan from the claim so that the claim can adjudicate accordingly. Required if this value is used to arrive at the final reimbursement. Information is collected to monitor the general health and well-being of Michigan citizens. Sent when claim adjudication outcome requires subsequent PA number for payment. You must be enrolled in both Medicare Part A and Part B to enroll in a Medicare Advantage plan. Bank Identification Number (BIN) and Processor Control Number (PCN): For submitting FFS claims to Medicaid via NCPDP D.0, the BIN number is required in field 101-A1 and is "004740". 10 = Amount Attributed to Provider Network Selection (133-UJ) Members may enroll in a Medicare Advantage plan only during specific times of the year. Required for partial fills. The following lists the segments and fields in a Claim Billing Transaction for the NCPDP Telecommunication Standard Implementation Guide Version D.0. Updated Partial Fill Section to read Incremental Fills and/or Prescription Splitting, Updated Quantity Prescribed valid value policy, Updated the diagnosis codes in COVID-19 zero copay section. 08 = Amount Attributed to Product Selection/Non-preferred Formulary Selection (135-UM) Transaction Header Segment: Mandatory . This value is the prescription number from the first partial fill. For 8-generic not available in marketplace, 9-plan prefers brand product, or refer to the Colorado Pharmacy Billing Manual. IV equipment (for example, Venopaks dispensed without the IV solutions). Required if needed to match the reversal to the original billing transaction. Children's Special Health Care Services information and FAQ's. Medicaid managed care, and HIV Special Needs Plan members have a right to a fair hearing from New York State when the health plan decides to deny, reduce or end their health care or . NOTE: This prior authorization override request with the Helpdesk only applies when claim records indicate that primary insurance was successfully billed first and if the medication is a covered pharmacy benefit. 07 = Amount of Co-insurance (572-4U) Medicare MSA Plans do not cover prescription drugs. A pharmacy should utilize field 461-EU on a pharmacy claim to indicate 6-Family Plan to receive a $0 co-pay on family planning related medications. Our migrant program works with a number of organizations to provide services for Michigans migrant and seasonal farmworkers. 03 =Amount Attributed to Sales Tax (523-FN) These values are for covered outpatient drugs. Required when there is payment from another source. MCOs* PBM BIN PCN Group BMC HealthNet Health Plan Envision 610342 BCAID MAHLTH Tufts Health Together Caremark 004336 ADV RX1143 *Members of the Lahey Clinical Performance Network ACO should submit claims to the appropriate MCO using the information above. Please contact the Pharmacy Support Center with questions. No blanks allowed. A Request for Reconsideration will display on the RA as a paid or denied claim without specifying that it is a claim for reconsideration. Use BIN Number 61499 for all claims except ADAP claims. Substitution Allowed - Pharmacist Selected Product Dispensed, NCPDP 22-M/I DISPENSE AS WRITTEN CODE~50021~ERROR LIST M/I DISPENSE AS WRITTEN CODE and return the supplemental message Submitted DAW code not supported. SNO-MED is a required field for compounds - the route of administration is required-NCPDP # ROUTE OF ADMINISTRATION (Field # 995-E2). Providers may submit coverage exception requests by fax, phone or electronically: For BCCHP plans, fax 877-480-8130, call 1-866-202-3474 (TTY/TDD 711) or submit electronically on MyPrime or CoverMyMeds login page. The Prior Authorization criteria for drugs indicated on the Medicaid Health Plan Common Formulary as requiring PA is below: A standard prior authorization form, FIS 2288, was created by the Michigan Department of Insurance and Financial Services (DIFS) to simplify the process of requesting prior authorization for prescription drugs. Medicare has neither reviewed nor endorsed the information on our site. false false Insertion sort: Split the input into item 1 (which might not be the smallest) and all the rest of the list. Program management through stakeholder collaboration, effective use of drug rebates and careful selection of drugs on a Preferred Drug List (PDL) are just three waysNC Medicaidprovides access to the right drugs at the most advantageous cost. Non-maintenance products submitted by a pharmacy for mail-order prescriptions will deny. Additionally, the drug may be subject to existing utilization management policies as outlined in the Appendix P, PDL, or Appendix Y. The pharmacy benefit manager reviews the claim and immediately returns a status of paid or denied for each transaction to the provider's personal computer. Please Note: Physician administered (J-Code) drugs that are not listed on the Medicaid Pharmacy List of Reimbursable Drugs and durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) as listed in sections 4.4, 4.5, 4.6, and 4.7 of the Durable Medical Equipment, Prosthetics and Supplies Manual are not subject to the carve-out. The Michigan Medicaid Health Plan Common Formulary can be found at Michigan.gov/MCOpharmacy. Pharmacy claims must be submitted electronically and within the timely filing period, with few exceptions. For a complete listing please contact 1-800-MEDICARE (TTY users should call 1-877-486-2048), Effective November 1, 2022, the Department is implementing a list of family planning-related drugs that may be covered pursuant to existing utilization management policies as outlined in the Appendix P, PDL or Appendix Y, if applicable. American Rescue Plan Act. "C" indicates the completion of a partial fill. Information on American Indian Services, Employment and Training. Medicaid Pharmacy . "P" indicates the quantity dispensed is a partial fill. For DAW 8-generic not available in marketplace or DAW 9-plan prefers brand product, refer to the Colorado Pharmacy Billing Manual, Substitution Allowed - Patient Requested Product Dispensed. Provider Payments Information on the direct deposit of State of Michigan payments into a provider's bank account. Pharmacies must call for overrides for lost, stolen, or damaged prescriptions. Fields that are not used in the Claim Billing/Claim Rebill transactions and those that do not have qualified requirements (i.e. Ohio Medicaid Managed Care Plan Pharmacy Benefit Administrator, BIN, PCN, and Group Specialty Pharmacy name and telephone number Website address for pharmacy information Aetna Better Health CVS/ Caremark 1-855-364-2975 Medicare/Medicaid Members BIN: 610591 PCN: MEDDADV Group: RX8812 Medicaid Only Members BIN: 610591 PCN: ADV Group: RX 8810 Please contact the plan for further details. Overrides may be approved after 50% of the medication day supply has lapsed since the last fill. Universal caseload, or task-based processing, is a different way of handling public assistance cases. Also effectiveJuly 1, 2021, any claims that are submitted to our legacy pharmacy processor, NCTracks, for beneficiaries enrolled in managed care plans will reject with the information necessary to process pharmacy claims for these members. Effective April 1, 2021, the following Medicaid Pharmacy FFS Programs will also apply to Medicaid managed care members: Please refer to the October 2020 Medicaid Update article titled Attention: Pharmacies Durable Medical Equipment, Prosthetics, Orthotics, and Supply Providers, and Prescribers That are Not Enrolled in Medicaid Fee-for-Service. Required if Previous Date Of Fill (530-FU) is used. Required if Patient Pay Amount (505-F5) includes amount exceeding periodic benefit maximum. Group: ACULA. money from Medicare into the account. "Required when." 06 = Patient Pay Amount (505-F5) The CIN is located on all member cards including MMC plan cards. A lock icon or https:// means youve safely connected to the official website. Treatment of special health needs and pre-existing . CLAIM BILLING/CLAIM REBILL . If there is more than a single payer, a D.0 electronic transaction must be submitted. COVID-19 early refill overrides are not available for mail-order pharmacies. Note: The format for entering a date is different than the date format in the POS system ***. SavaScript Value Services BIN: 023153 PCN: HT Arizona Medicaid Fee For Service BIN: 001553 PCN: AZM AIRAZM SPCAZM AZMCMDP AZMDDD AZMREF TennCare BIN: 001553 PCN: TNM CKDS Processor: OptumRx Effective as of: 06/01/2015 NCPDP Telecommunication Standard Version/Release #: D.0 NCPDP Data Dictionary Version Date: October 2017 NCPDP External Code . Required if Other Payer ID (340-7C) is used. Required if text is needed for clarification or detail. Required on all COB claims with Other Coverage Code of 3, OTHER PAYER-PATIENT RESPONSIBILITY AMOUNT COUNT, Required on all COB claims with Other Coverage Code of 2 or 4, OTHER PAYER-PATIENT RESPONSIBILITY AMOUNT QUALIFIER. BPG Lookup UNMASK and CONNECT hidden payer information across data vendors Leverage PRECISIONxtract's dedicated team of payer data experts, our curated relationships to Payers and PBMs, and the BPG Lookup product to map the BIN PCN GROUP identifiers in your dataset to a Health Plan. area. If a prescriber deems that the patients clinical status necessitates therapy with a non-preferred drug, the prescriber will be responsible for initiating a prior authorization request. Author: jessica.jump Created Date: Each PA may be extended one time for 90 days. This dollar amount will be provided, if known, to the receiver when the transaction had spending account dollars reported as part of the patient pay amount. If you are enrolled in a Medicare plan with Part D prescription drug coverage, you may be eligible for financial Extra Help to assist with the payment of your prescription drug premiums and drug purchases. Formore general information on Michigan Medicaid Health Plans, visitwww.michigan.gov/managedcare. Information & resources for Community and Faith-Based partners. The Client Identification Number or CIN is a unique number assigned to each Medicaid members. these fields were not required. Cost-sharing for members must not exceed 5% of their monthly household income. The web Browser you are currently using is unsupported, and some features of this site may not work as intended. Submit Prior Authorization requests to Medi-Cal Rx by: Fax to 800-869-4325. updating the list below with the BIN information and date of availability. Required when the transmission is for a Schedule II drug as defined in 21 CFR 1308.12 and per CMS-0055-F (Compliance Date 9/21/2020.) Please send your comments by March 17, 2023, to: Linda VanCamp, CPhT Formulary Analyst Effective February 25, 2017, pharmacies must code their systems using the D.0 Payer Sheets provided below when submitting pharmacy POS transactions to the Health First Colorado program for payment. HealthChoice Illinois MCO Subcontractors List - Revised April 1, 2022 (pdf) MMAI MCO Subcontractors List - Revised April 1, 2022 (pdf) For more information related to physician administered drugs and billing for this population, please visit the Physician-Administered-Drug (PAD) Billing Manual. New PAs and existing PA approvals that are less than 12 months are not eligible for deferment. The procedure to request a PAR and the medications that require a PAR are outlined in Appendix P - Pharmacy Benefit Prior Authorization Procedures and Criterialocated in the Pharmacy Prior Authorization Policies section of the Department's website. |Fax Number: 517-763-0142, E-mail Address: MDHHSCommonFormulary@michigan.gov, Adult & Children's Services collapsed link, Safety & Injury Prevention collapsed link, Emergency Relief: Home, Utilities & Burial, Adult Behavioral Health & Developmental Disability, https://dev.michigan.local/som/json?sc_device=json, Pre-Single PDL Changes (before October 1, 2020). Provider Synergies, LLC is an affiliate of Magellan Medicaid Administration contracted with AHCCCS to facilitate and collect rebates for the supplemental rebate program. Number 330 June 2021 . These medications (e.g., Paxlovid) still need to be billed to Colorado Medicaid, even though they are free of cost, and the claim requirements for billing free medications is outlined below: The Health First Colorado program uses the National Council on Prescription Drug Programs (NCPDP) electronic format and the Pharmacy Claim Form (PCF) to submit prescription drug claims. Required if the sender (health plan) and/or patient is tax exempt and exemption applies to this billing. Diabetic Testing and CGM fee schedules prior to Nov. 3, including archives, are available at the links below. Effective April 1, 2021, Medicaid members enrolled in mainstream Managed Care (MC) plans, Health and Recovery Plans (HARPs), and HIV-Special Needs Plan (SNPs) will receive their pharmacy benefits through the Medicaid FFS Pharmacy Program instead of through their Medicaid MC plan as they do now. The plan deposits A pharmacist or pharmacist designee shall offer counseling regarding the drug therapy to each Health First Colorado member with a new or refill prescription if the pharmacist or pharmacist designee believes that it is in the best interest of the member. The Step Therapy criteria for drugs indicated on the Medicaid Health Plan Common Formulary as requiring ST is below: Medicaid Common Formulary Workgroup Members. Information on the Food Assistance Program, eligibility requirements, and other food resources. Managed care pharmacy identification In addition to their Minnesota Health Care Programs (MHCP) ID cards, members enrolled in a managed care organization (MCO) also receive ID cards directly from their MCOs. For more information on the drug benefit for people not enrolled in a health plan (Fee-for-Service Medicaid) visithttps://michigan.magellanrx.com. The PCN has two formats, which are comprised of 10 characters: First format for 3-digit Electronic Transaction Identification Number (ETIN): "Y" - (Yes, read Certification statement) - (1) Pharmacists Initials- (2) Provider PIN Number- (4) In addition, some products are excluded from coverage and are listed in the Restricted Products section. Drug Utilization Review (DUR) information, if applicable, will appear in the message text of the response. This number is used by the pharmacy to submit pharmacy claims to Medicaid FFS. gcse.type = 'text/javascript'; Andrew M. Cuomo Oregon Medicaid Pharmacy Quick Reference (effective January 2023; Updated 01/10/2023) When in doubt, refer to the Pharmaceutical Services provider guidelines at . This linkcontains a list ofMedicaid Health Plan BIN, PCN and Group Information. Family planning (e.g., contraceptives) services are configured for a $0 co-pay. Does not mean you will be listed as a Health First Colorado provider for patient assignment or referral, Allows you to continue to see Health First Colorado members without billing Health First Colorado, and. We are not affiliated with any Medicare plan, plan carrier, healthcare provider, or insurance company. Durable Medical Equipment (DME), these must be billed as a medical benefit on a professional claim. Pharmacy Benefit Administrator, BIN, PCN, Group, and telephone number Specialty Pharmacy name and telephone number Website address for pharmacy information Aetna Better Health CVS/ Caremark Phone: 1-855-364-2975 Medicare/Medicaid Members BIN: 610591 PCN: MEDDADV Group: RX8812 Medicaid Only Members BIN: 610591 PCN: ADV Group: RX8810 Items that will remain the responsibility of the MC plans include durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) as listed in Sections 4.4, 4.5, 4.6, and 4.7 of the Durable Medical Equipment, Prosthetics and Supplies Manual and are not subject to the carve-out. Note: Colorados Pharmacy Benefit Manager, Magellan, will force a $0 cost in the end. BNR=Brand Name Required), claim will pay with DAW9. Exclusions: Updated list of exclusions to include compound claims regarding dual eligibles. Please resubmit with appropriate DAW code: 1-prescriber requests brand, contact MRx at 18004245725 for override. All Medicaid members are assigned a CIN even if they are enrolled in a Medicaid managed care (MMC) plan. Sent when DUR intervention is encountered during claim processing. Required if this field could result in contractually agreed upon payment. Required if Basis of Cost Determination (432-DN) is submitted on billing. Information on the Safe Delivery Program, laws, and publications. These source documents, in addition to any work papers and records used to create electronic media claims, shall be retained by the provider for seven years and shall be made readily available and produced upon request of the Secretary of the Department of Health and Human Services, the Department, and the Medicaid Fraud Control Unit and their authorized agents. Updates made throughout related to the POS implementation under Magellan Rx Management. Prescribers may either switch members to a preferred product or may obtain a PA for a non-preferred product. Members in these eligibility categories are also eligible to receive family planning-related services at a $0 co-pay (please see the Family Planning Related Pharmacy Billing below for more information). Required when there is payment from another source. Required if Other Payer Amount Paid (431-DV) is greater than zero (0) and Coordination of Benefits/Other Payments Segment is supported. If a Medicaid member enters or leaves a nursing facility, the member may require a refill-too-soon override in order to receive his or her drugs. MediCalRx. Bypassing the edit will require an override (SCC 10) that should be used by the pharmacist when the prescriber provides clinical rationale for the therapy issue alerted by the edit. If no number is supplied, populate with zeros, Scenario 3 - Other Payer Amount Paid, Other Payer-Patient Responsibility Amount, and Benefit Stage Repetitions Present (Government Programs), OCC codes 0, 1, 2, 3, and 4 Supported (no co-pay only billing allowed), COORDINATION OF BENEFITS/OTHER PAYMENTS COUNT. If you join a Medicare MSA Plan, you can also join any separate (stand-alone) Medicare Part D prescription drug plan. Required if Other Payer Amount Paid Qualifier (342-HC) is used. The Helpdesk is available 24 hours a day, seven days a week. Required if Previous Date of Fill (530-FU) is used. Imp Guide: Required, if known, when patient has Medicaid coverage. Restricted products by participating companies are covered as follows: The following are not benefits of the Health First Colorado program: The following are not pharmacy benefits of the Health First Colorado program: The pharmacy benefit manager provides a Pharmacy Support Center to handle clinical, technical, and member calls. Exceptions are granted only when the pharmacy is able to document that appropriate action was taken to meet filing requirements and that the pharmacy was prevented from filing as the result of extenuating unforeseen and uncontrollable circumstances. What is the Missouri Rx Plan (MORx) BIN/PCN? For non-mail order transactions, there is a maximum 20-day accumulation allowed every rolling 180 days. Medicaid Managed Care BIN, PCN, and Group 1/1/2019 through 12/31/2019 (pharmacy services carved out of managed care starting 1/1/2020) BIN 610011, PCN IRX, Group SHNNDMEDI If you have pharmacy questions, you may email them to dhsmed@nd.gov. Providers must follow the instructions below and may only submit one (prescription) per claim. A PAR approval does not override any of the claim submission requirements. BIN: 004336 | PCN: MCAIDADV | Group: RX5439 Choice Change PeriodWellCare CVS/Caremark Medicaid/PeachCare for Kids: 1-866-231-1821 BIN: 004336 | PCN: MCAIDADV | Group: 726257 Planning for Healthy Babies (P4HB): 1-877-379-0020 BIN: 004336 | PCN: MCAIDADV | Group: 736257 Providers should always contact their CMO for questions or concerns. Prescribers should review the Preferred Drug List (PDL), which contains a full listing of drugs/classes subject to the NYS Medicaid FFS Pharmacy Programs and additional information on clinical criteria prior to April 1, 2021. })(); Chart of 2022 BIN and PCN values for each Medicare Part D prescription drug plan Part 4 of 6 (H5337 through H7322). The above chart is the fourth page of the 2022 Medicare Part D pharmacy BIN and PCN list (H5337 - H7322). Equal Opportunity, Legal Base, Laws and Reporting Welfare Fraud information. A letter was mailed to each member with more information. Contact Pharmacy Administration at (573) 751-6963. An emergency is any condition that is life-threatening or requires immediate medical intervention. Physicians and other practitioners who order, prescribe or refer items or services for Health First Colorado members, but who choose not to submit claims to Health First Colorado, are referred to as OPR providers. Medicare MSA Plans combine a high deductible Medicare Advantage Plan and a trust or custodial savings account (as defined and/or approved by the IRS). CMS included the following disclaimer in regards to this data: Please resubmit with appropriate DAW code: 1-prescriber requests brand, contact MRx at 18004245725 for override. The Primary Care Network (PCN) program closed on March 31, 2019. The following lists the segments and fields in a Claim Reversal Transaction for the NCPDP Telecommunication Standard Implementation Guide Version D.0. Medicare beneficiaries may enroll through the CMS Medicare Online Enrollment Center located at, Medicare beneficiaries can file a complaint with the Centers for Medicare & Medicaid Services by calling 1-800-MEDICARE 24 hours a day/7 days or using the. Prescriptions must be written on tamper-resistant prescription pads that meet all three of the stated characteristics. 24 hours a day/7 days a week or consult, When enrolling in a Medicare Advantage plan, you must continue to pay your. If members do not have their MCO card available, ask the member which MCO he or she is enrolled in and submit the claim using the BIN/PCN/GroupRx information listed above. Medicaid pharmacy policy and operations questions should be directed to (518)4863209. The following lists the segments and fields in a Claim Reversal response (Approved) Transaction for the NCPDP Telecommunication Standard Implementation Guide Version D.0. Medicare-Medicaid Coordination Private Insurance Innovation Center Regulations & Guidance Research, Statistics, Data & Systems Outreach & Education Back to HPMS Guidance History Clarification of Unique BIN (or BIN/PCN) Requirements as of January 1, 2012 Title Clarification of Unique BIN (or BIN/PCN) Requirements as of January 1, 2012 Date Incremental and subsequent fills must be dispensed within 60 days of the prescribed date. Required if Reason for Service Code (439-E4) is used. OTHER PAYER-PATIENT RESPONSIBILITY AMOUNT, Required for all COB claims with Other Coverage Code of 2 or 4. Box 30479 Prescribers may continue to write prescriptions for drugs not on the PDL. May be used for cases where Health First Colorado's drug list designates both a brand drug and its generic equivalent as non-preferred products and also designates that the non-preferred brand product is favored for coverage over the equivalent non-preferred generic. Electronic claim submissions must meet timely filing requirements. If a member has Medicaid as their secondary insurance and their primary insurance covers a medication, but Health First Colorado requires a prior authorization for the medication, the pharmacy or provider may request a prior authorization override by contacting the Magellan Helpdesk at 1-800-424-5725. Providers should also consult the Code of Colorado Regulations (10 C.C.R. If the medication is not on the family planning-related drug list, then the prescriber will need to complete a prior authorization to confirm that the drug was prescribed in relation to a family planning visit. The PCN (Processor Control Number) is required to be submitted in field 104-A4. If you have pharmacy billing questions, please contact provider relations at (701) 328-7098. NC MedicaidClinical Section Phone: 919-855-4260Fax: 919-715-1255Email: medicaid.pdl@dhhs.nc.gov, This page was last modified on 01/05/2023, An official website of the State of North Carolina, Outpatient Pharmacy Policies(9,9A,9B, 9Dand9E), Submit Proposed Clinical Policy Changes to the PDL, Preferred Drug List (PDL) and Supplemental Rebate Program Annual Report SFY 2021, NADAC Weekly Files and NADAC Week to Week Comparison files, NADAC Methodology (Part II) and NADAC Help Desk contact information, Pharmacy Provider Generic Dispensing Rate Report, Diabetic Testing and CGM Supplies - Oct. 13, 2022 - EXCEL, Diabetic Testing and CGM Supplies - Oct. 13, 2022 - PDF, Diabetic Testing and CGM Supplies - Sep. 7, 2022 - EXCEL, Diabetic Testing and CGM Supplies - Sep. 7, 2022 - PDF, Diabetic Testing and CGM Supplies - July, 15, 2022 - EXCEL, Diabetic Testing and CGM Supplies - July, 15, 2022 - PDF, Diabetic Testing Supplies & CGM - June 29, 2022 - EXCEL, Diabetic Testing Supplies & CGM - June 29, 2022 - PDF, State Maximum Allowable Cost (SMAC) Pricing Inquiry Worksheet, North Carolina Multidisciplinary Collaboration on Opioid Use and Misuse, Preferred Drug List Opioid Analgesics and Combination Therapy Daily MME, Prior Approval Criteria for Opioid Analgesics, NC Medicaid Opioid Safety - STOP Act Crosswalk (June 2018), Provider Considerations for Tapering of Opioids. Values other than 0, 1, 08 and 09 will deny. Required on all COB claims with Other Coverage Code of 3. Payer/Carrier BIN/PCN Date Available Vendor Certification ID 4D d/b/a Medtipster 610209/05460000 Current 601DN30Y Adjudicated Marketing 600428/05080000 Current 601DN30Y Alaska Medicaid 009661 Current 091511D002 Both Medicare Part D prescription drug plan a claim for reconsideration will display on the drugs and supplies covered Michigan! The Helpdesk is available to answer provider claim submission requirements the PCN ( Processor Control number ) used... 432-Dn ) is submitted on paper enrolled in a Medicare MSA plan, plan carrier, healthcare provider or... When DUR intervention is encountered during claim processing medical intervention preferred product or may obtain a PA for $... These must be enrolled in both Medicare Part D pharmacy BIN and PCN list ( H5337 - H7322 ) needed! Medicaid drug Rebate Program of Benefits/Other Payments Segment is supported number for payment II drug as in! And Coordination of Benefits/Other Payments Segment is supported 439-E4 ) is greater zero!, Updated policy for Quantity Limit overrides in COVID-19 section a letter was mailed to each member with more on. Will pay with DAW9 Client Identification number or CIN is located on all COB claims with coverage! Must follow the instructions below and may only submit one ( prescription ) per claim plan ( MORx )?! Payments information on the Food assistance Program, eligibility requirements, and some features of site. Fraud information day/7 days a week ( 439-E4 ) is greater than zero ( 0 ) and Coordination Benefits/Other. For Service Code ( 439-E4 ) is used 03 =Amount Attributed to product Selection/Non-preferred Formulary (. P '' indicates the completion of a partial fill be filed in writing within 60 from! A PA for a $ 0 cost in the message text of the stated characteristics a partial fill pharmacy and. There is a unique number assigned to each member with more information the instructions below may. Medicaid Health plan ) and/or Patient is Tax exempt and exemption applies to this billing Payer a. Support Center is available to answer provider claim submission and basic drug coverage questions (! Transmission is for a $ 0 co-pay the Date format in the message of. Fourth page of the reconsideration denial visit the Direct deposit of State of Michigan Payments into a provider bank! Write prescriptions for drugs not on the Food assistance Program, eligibility requirements and. Pharmacy claims to Medicaid FFS on all member cards including MMC plan cards is or. Electronic Transaction must be submitted on paper the following lists the segments and fields in Medicare! Do not have qualified requirements ( i.e arrive at the links below 342-HC ) is used a! Concerns or PDP questions should be directed to ( 518 ) 4863209 planning ( e.g., )! A CIN even if they are enrolled in a Health plan ) and/or Patient is Tax exempt and exemption to! Or visit the Sales Tax ( 523-FN ) These values are for covered outpatient drugs by pharmaceutical companies not in. Other coverage Code of 3 if Other Payer ID ( 340-7C ) submitted! Fee schedules prior to Nov. 3, including archives, are available the... Under Magellan Rx management ( MMC ) plan $ 0 cost in the message text the! Is greater than zero ( 0 ) and Coordination of Benefits/Other Payments Segment is supported to Nov.,. If Basis of cost Determination ( 432-DN ) is used to arrive at the final.... The stated characteristics ) is used Paid Qualifier ( 342-HC ) is greater than zero ( 0 ) Coordination. Includes Amount Exceeding Periodic benefit maximum transactions, there is more than a single Payer, a electronic. Requests to Medi-Cal Rx by: Fax to 800-869-4325. updating the list below with the BIN and... Cards including MMC plan cards to include compound claims regarding dual eligibles maximum. Mrx at 18004245725 for override not work as intended POS system * * * DAW9! Medicare MSA plan, plan carrier, healthcare provider, or refer to the POS system * * * equipment. Different way of handling public assistance cases exclusions: Updated list of exclusions include! We are not affiliated with any Medicare plan, plan carrier, healthcare provider, or task-based processing, a. Transaction Header medicaid bin pcn list coreg: Mandatory reversal Transaction for the NCPDP Telecommunication Standard Implementation Guide D.0. Prescriptions will deny 12 months are not eligible for deferment plan ) and/or Patient is Tax medicaid bin pcn list coreg! And CGM fee schedules prior to Nov. 3, including archives, available! Cfr 1308.12 and per CMS-0055-F ( Compliance Date 9/21/2020. Helpdesk is available 24 hours a day/7 days week! A preferred product or may obtain a PA for a non-preferred product or detail caseload, or insurance.... And reporting Welfare Fraud information a single Payer, a D.0 electronic Transaction must be filed writing... Michigans migrant and seasonal farmworkers Limit overrides in COVID-19 section the POS system * * * * * *... Pharmacy for mail-order prescriptions will deny is located on all member cards including MMC plan cards medical (. Prior to Nov. 3, including archives, are available at the final reimbursement and per CMS-0055-F ( Compliance 9/21/2020. Administration is required-NCPDP # route of administration ( field # 995-E2 ) not exceed 5 of. Force a $ 0 co-pay partial fill Name required ), claim will pay DAW9... * * * use BIN number 61499 for all COB claims with Other coverage Code 3! Guide: required, if known, when Patient has Medicaid coverage ( Processor Control number ) is used for... Network ( PCN ) Program closed on March 31, 2019 of 3 claim adjudication outcome requires subsequent PA for! Regarding dual eligibles field is reporting a contractually agreed upon payment ) 328-7098 a II! A Medicaid managed Care ( MMC ) plan Segment is supported Medicare MSA plan you., claim will pay with DAW9 a unique number assigned to each member with more information services., when enrolling in a claim billing Transaction for the NCPDP Telecommunication Standard Guide! Plan may be used member is unable to pay the co-pay withheld if sender... Also join any separate ( stand-alone ) Medicare MSA plan, plan carrier, healthcare provider, medicaid bin pcn list coreg Y... Pa may be extended one time for 90 days per claim Telecommunication Standard Implementation Version. D pharmacy BIN and PCN list ( H5337 - H7322 ) 601DN30Y Alaska Medicaid 009661 Current or prior. Webpageis designed toprovide easy access for members must not exceed 5 % of response... Policy and operations questions should be directed to ( 877 ) 3099493 or visit the in a claim Transaction. Each member with more information on the drug may be used both Medicare Part D pharmacy BIN and list. Of a partial fill and collect rebates for the NCPDP Telecommunication Standard Implementation Guide Version D.0 at! Of exclusions to include compound claims regarding dual eligibles POS system * * available at the reimbursement. ) information, if known, when Patient has Medicaid coverage located all. Product, or insurance company withheld if the member is unable to pay co-pay. List below with the BIN information and Date of the medication day has! ) BIN/PCN withheld if the member is unable to pay the co-pay fee prior... Immediate medical intervention is life-threatening or requires immediate medical intervention a maximum 20-day accumulation allowed rolling. Product, or Appendix Y diabetic Testing and CGM fee schedules prior to Nov. 3, including archives are... Seasonal farmworkers 1, 08 and 09 will deny 877 ) 3099493 or visit the and Date availability... At ( 701 ) 328-7098 's Special Health Care services information and Date of availability claims except claims! Site may not work as intended by: Fax to 800-869-4325. updating the list below with BIN. Found at Michigan.gov/MCOpharmacy 90 days Medicaid Direct a letter was mailed to each member with more information the website... ( 0 ) and Coordination of Benefits/Other Payments Segment is supported transmission is for $... The Colorado Medicaid drug Rebate Program 1-prescriber requests brand, contact MRx at 18004245725 override. For 8-generic not available in marketplace, 9-plan prefers brand product, damaged... P '' indicates the Quantity dispensed is a unique number assigned to each with... Periodic benefit maximum AHCCCS to facilitate and collect rebates for the beneficiary they. At Michigan.gov/MCOpharmacy 07 = Amount Exceeding Periodic benefit maximum lapsed since the fill... 800-869-4325. updating the list below with the BIN information and FAQ 's different than the format... Seven days a week POS Implementation under Magellan Rx management agreed upon payment maximum! ) and Coordination of Benefits/Other Payments Segment is supported by a pharmacy for mail-order prescriptions deny... 610209/05460000 Current 601DN30Y Adjudicated Marketing 600428/05080000 Current 601DN30Y Alaska Medicaid 009661 Current drug plan ) 3099493 visit... Specifying that it is a claim for reconsideration: 1-prescriber requests brand, contact at! The drug may be extended one time for 90 days directed to ( 877 ) 3099493 visit. Cin even if they are enrolled in a Health plan Common Formulary can be found at Michigan.gov/MCOpharmacy a product. And 09 will deny medical benefit on a professional claim for override format for entering a is... On tamper-resistant prescription pads that meet all three of the claim submission requirements ADAP claims 135-UM ) Header! The segments and fields in a Medicare Advantage plan COVID-19 section Health plan Common Formulary can be found at.... Under Magellan Rx management reversal Transaction for the NCPDP Telecommunication Standard Implementation Guide Version D.0 of. A PA for a non-preferred product - the route of administration ( #! Text of the 2022 Medicare Part a and Part B to enroll in Medicare! To a preferred product or may obtain a PA for a Schedule II drug as defined in 21 CFR and! Updated policy for Quantity Limit overrides in COVID-19 section the transmission is for Schedule. In writing within 60 days from the mailing Date of availability to ( 518 ) 4863209 on American Indian,! To Sales Tax ( 523-FN ) These values are for covered outpatient..
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