RXBIN: 004336

RXPCN: ADV

RXGRP: RX0456

Member ID Format: 11 digits, alphanumeric

Person Code : 2 digits, required

*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.

Please find attached updated Patient Choice/Therapy First/Therapy First Plus vD.0 payer sheets.  

Effective IMMEDIATELY, Change Healthcare will require you to submit components of Patient Pay Amount using Other Payer Patient Responsibility Amount Qualifiers 01 – 05, 07 -13 in field 351-NP.  

Please disregard this notice if you currently submit these components.   

Sincerely,  

Change Healthcare Provider Relations