*Please see attached PDF for more information.

*Please see attached PDF for more information.

Process for durable medical equipment (DME) billing for pharmacies

AmeriHealth Caritas Iowa has received a number of inquiries from pharmacies about our DME billing process. Here are the key things pharmacies need to know when submitting DME claims:

• PerformRx is not able to process DME claims through their pharmacy point-of-sale system.
• Pharmacies that provide DME supplies must submit claims to AmeriHealth Caritas Iowa in order for claims to be processed.
• To submit a DME claim, pharmacies and/or DME suppliers can use the CMS-1500 professional claim form and submit electronically or via paper.

As a reminder, CVS Caremark® is dedicated to assisting Providers and Eligible Persons in response to emergencies resulting from natural disasters, severe weather, etc. where medical records are either destroyed or not accessible. In the event of a presidential (or other governmental) emergency declaration, CVS Caremark will allow an override code to override the refill-too-soon edit. Allowances for non-Medicare Part D plans may vary by Plan Sponsor. By calling the Pharmacy Help Desk, Provider will be connected to the appropriate staff member who can provide: • An emergency override code per claim for an excessive utilization, or "refill-too-soon" reject when a beneficiary does not have a recently filled medication due to loss from severe weather or other emergency • The type of medication a beneficiary was taking prior to the emergency and other pertinent information, such as prescribing physician, dosage, quantity, days supply, etc. Call the appropriate Pharmacy Help Desk number provided on the left or other plan-specific Pharmacy Help Desk number as indicated on the back of the member’s ID card.