2

Sep

2016

Medimpact: Processing Information for Vensurance

Effective: September 1, 2016

MedImpact Healthcare Systems, Inc. began processing for Vensurance as of 9/1/2016.

Since you have already agreed to participate with MedImpact, there will be no information for you to return. Enclosed please find the following information to assist you in processing claims:

2

Sep

2016

OptumRx: Avoid Penalties by Not Collecting Cost-Share for Covered Medicare Services from Qualified Medicare Beneficiaries

Effective:

As a reminder, Qualified Medicare Beneficiaries (QMBs), including some UnitedHealthcare Medicare Advantage members, are not responsible for any remaining balance after payment from Medicare for covered services. The Centers for Medicare & Medicaid Services (CMS) guidelines state that Medicare-contracted care providers may not collect cost-share from these patients. To determine if you can bill Medicaid as the secondary payer, please review the information found in the Benefit Stage Qualifier field of the approved Medicare Advantage claim. Code 50 in that field indicates that the claim was paid under Part B benefits, even if the drugs were processed using a Part D Processor ID or control number. This is because Medicare Advantage, also known as Part C, combines Part A, Part B and Part D benefits. If this is the case and the member is an active QMB, you can bill the dollar amount found in the Qualifier Amount field to Medicaid. If Medicaid does reimburse you, that payment must be accepted as full payment. If a balance remains or you’re unable to bill Medicaid as the secondary payer, your office must provide medications or supplies to UnitedHealthcare Medicare Advantage members without billing them for the balance. Care providers who bill patients who are QMBs for any remaining balances may be penalized as established in Section 1902(n)(3)(C) of the Social Security Act. If you have any questions, please call the following OptumRx Help Desk numbers any time. Thank you.

2

Sep

2016

Express Scripts: Emergency Override for "Refill Too Soon" due to Tropical Storm in Florida

Effective: Immediately

The governor of Florida has extended the State of Emergency to include the following counties: Escambia, Santa Rosa, Okaloosa, Walton, Holmes, Washington, Manatee, Osceola, and Sarasota. These counties are in addition to the original counties included in the declaration: Alachua, Baker, Bay, Bradford, Brevard, Calhoun, Citrus, Clay, Columbia, Dixie, Duval, Flagler, Franklin, Gadsden, Gilchrist, Gulf, Hamilton, Hernando, Hillsborough, Jackson, Jefferson, Lafayette, Lake, Leon, Levy, Liberty, Madison, Marion, Nassau, Orange, Pasco, Pinellas, Polk, Putnam, Seminole, St. Johns, Sumter, Suwannee, Taylor, Union, Volusia and Wakulla. Due to this issuance, Express Scripts has implemented Emergency Refill Too Soon Procedures in the state of Florida for Part D and Medicare Advantage plans. Effective immediately, if a patient from the disaster area attempts to fill a prescription for lost or damaged medication resulting from the disaster, and the claim rejects with a Reject 79 "Refill Too Soon," the pharmacy should enter override code 91100000001 in NCPDP vD.0 field 462-EV "Prior Auth Number Submitted."

2

Sep

2016

Magellan: Addition of Maxium Allowable Cost (MAC) Pricing to Diabetic Supplies

Effective: September 5, 2016

Addition of Maximum Allowable Cost (MAC) Pricing to Diabetic Supplies Magellan Medicaid Administration implemented a new MAC to all lancets effective August 24, 2016. Additionally, all other diabetic supplies will be subject to MAC pricing effective September 5, 2016. Please make a note of the new pricing below to ensure that you are purchasing and billing for the lowest cost alternative for these supplies.

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