Dear
Pharmacy Partner,
Below
is an update from our prior January 6, 2017 email communication regarding
changes to our Opioid Morphine Equivalent Dose (MED) program that placed edits
at the point of sale. Please note the following changes:
- Effective
April 1, 2017, the hard edit (claim requires MagellanRx to override) that
applied when an enrollee exceeds MED of 299mg/day and required an override
by MagellanRx Medicare Part D will be DISCONTINUED.
- Effective
May 1, 2017, the soft edits (claim can be overridden by the pharmacy with
appropriate service codes) that applied when an enrollee exceeds MED of
119mg/day OR 3 or more prescribers OR 3 or more pharmacies will be REVISED
to require all three thresholds. The soft edit will now apply only
if the claim shows that the enrollee exceeds MED of 119mg/day AND 3 or
more prescribers AND 3 or more pharmacies.
You
will continue to use the same codes as noted in the previous email for the
Opioid MED program to override the revised soft edit. We have again
provided them in this communication.
|
DUR/PPS
Segment
Segment
Identification (111-AM) = “Ø8”
|
Claim Billing/Claim Re-bill
|
|
Field #
|
NCPDP Field Name
|
Value
|
Payer
Usage
|
Payer Situation
|
|
439-E4
|
REASON
FOR SERVICE CODE
|
|
RW
|
For
Opioid MED Program, soft reject of opioid DUR warning, use value of “AN”,
“DR” or “MX”.
|
|
44Ø-E5
|
PROFESSIONAL SERVICE CODE
|
|
RW
|
For Opioid MED Program, values of
“AS”, “DE”, “DP”, “M0”, “MB”, “MP”, “PA”, or “PM" are required.
.
|
Please
continue to refer to the posted payer sheet on the MagellanRx provider portal
at https://medicare.magellanrx.com/
under the Provider tab.
Contact Information
Pharmacy Web Portal: https://medicare.magellanrx.com
If you have any additional questions, please
contact the MagellanRx Medicare Contact Center:
- Phone:
1-800-424-5870
- Fax:
1-800-424-5872