2

Sep

2016

OptumRx: IMPORTANT INFORMATION REGARDING Illinois Medicaid Provider Enrollment Revalidations

Effective: September 24, 2016

  As stated in previous notices, the Centers for Medicare and Medicaid Services requires all Medicaid providers’ enrollments to be revalidated by September 24, 2016. The Department strongly recommends that all provider enrollments be submitted in IMPACT by August 31, 2016 in order for staff to review and approve the enrollments prior to the revalidation deadline. Failure to submit a provider’s enrollment for revalidation and approval will result in disenrollment from Illinois Medicaid on September 25, 2016. Therefore, prior to providing any future Medicaid services and submitting claims, the provider must re-enroll as a new provider into the program and retroactive requests will not be allowed. More information on the IMPACT system plus frequently asked questions, webinars and other training guides are available at the IMPACT website: http://www.illinois.gov/hfs/impact/Pages/default.aspx. If you have any additional questions or need assistance, please contact the IMPACT Help Desk:  By email: IMPACT.HELP@illinois.gov  By phone: (877) 782-5565, option #1 For questions regarding this communication or other pharmacy related claims processing issues call: Provider Relations (877) 633-4701 or e-mail provider.relations@optum.com Please distribute immediately.

2

Sep

2016

Express Scripts: Part D and Medicare Advantage plans ONLY - Emergency Overrride for "Refill Too Soon" due to Tropical Storm in Georgia

Effective: Immediately

The governor of Georgia has issued a state of emergency for the following counties due to tropical storm Hermine: Appling, Atkinson, Bacon, Ben Hill, Berrien, Brantley, Brooks, Bryan, Bulloch, Burke, Camden, Candler, Charlton, Chatham, Clinch, Coffee, Colquitt, Cook, Crisp, Decatur, Dodge, Echols, Effingham, Emanuel, Evans, Glynn, Grady, Irwin, Jeff Davis, Jefferson, Jenkins, Johnson, Lanier, Laurens, Liberty, Long, Lowndes, McIntosh, Mitchell, Montgomery, Pierce, Richmond, Screven, Seminole, Tattnall, Telfair, Thomas, Tift, Toombs, Treutlen, Turner, Ware, Wayne, Wheeler, Wilcox and Worth. Due to this issuance, Express Scripts has implemented Emergency Refill Too Soon Procedures in the Georgia counties listed above 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

Express Scripts: Part D and Medicare Advantage plans ONLY - Emergency Overrride for "Refill Too Soon" due to Tropical Storm in Florida

Effective: Immediately

The governor of Florida has issued a State of Emergency for the following counties in the state of Florida due to the tropical storm: 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

CVS Caremark: Sheets: Natural Disaster Emergency Override Procedure

August 31, 2016

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.

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