Mirixa is pleased to announce that a few more 2015 MTM Programs have launched or are launching in the next few days on the MirixaPro platform. Be sure to check your MirixaPro queue to see which of your patients qualify for service and to review the updated program information for each. Schedule your patients now for helpful services that are free to the patients and allow you to receive compensation for your time and expertise.

Cigna-HealthSpring currently utilizes a clinical program which is designed to review a member’s prescription history for possible drug related concerns. The goal is to improve the quality and cost effectiveness of dispensed medications by ensuring adjudicated prescriptions are clinically appropriate. The edits in place can be easily overridden by using the appropriate DUR/PPS Reason and Result codes found below. This edit assesses the total daily dose based on FDA approved maximum dosing information. The edit identifies single incoming claims of concern as well as overlapping claims with the member’s history based on specific ingredients. The edit will be triggered if the total daily dose exceeds the FDA-defined maximum daily dose.

Effective 01/01/2015, the Patient Residence Code and the Pharmacy Service Type now require valid Part D Values. If not submitted the following reject codes will occur:

4X – Patient Residence code

U7 – Pharmacy Service Type

Additional cases for the HealthSpring Star Ratings Program will be released to pharmacies on Monday, November 24th.