• This issue of CAPS Newsletter discusses the following topics:

  
  

  • X-DEA Prescription Requirements
  • Prescriptions Written by a Nurse Practitioner (NP) or Physician Assistant (PA)
  • Insulin Part B vs. Part D Billing
  • Issuance of Multiple Schedule II Prescriptions
  • Biennial Controlled Substance Inventory Count
  • “Use as Directed”, “As Directed”, “Per Sliding Scale” Directions
  • Multiple Physicians Listed on a Prescription
  • Humana Audit $5 Penalty Fee
  • OIG/SAM Monthly Exclusion Checks 
  • Meet your CAPS Team

To help ensure claims for insulin are paid under the correct benefit, we want to remind you to please notify the prescriber and the member that a plan review is required for short-acting insulin administered in a pump to process under the Part B benefit for UnitedHealthcare Medicare Advantage members.

MedImpact Healthcare Systems, Inc. began processing for HealthSpan Integrated Care- Medicare Cost Part B as of 02/02/2015.

Effective January 1, 2015, Prime Therapeutics (Prime) will begin processing Medicare Part B and Part D claims for Covered Persons of BlueCross BlueShield of Minnesota (BCBSMN) Platinum Blue with Rx (Cost). This new plan will offer an Rx option with a single ID card.

Effective January 1, 2015, Blue Cross Blue Shield of Illinois, Montana, New Mexico and Oklahoma will be utilizing a new Processor Control Number (PCN) for their Blue Cross Medicare Advantage HMO and PPO Part B business.