SilverScript Insurance Company requires all of its contracted providers to be aware of and comply with CMS’ Provider Marketing rules and regulations. This summary of Medicare guidelines governs how you can and cannot inform or educate patients about enrollment and plan information.

The 2016 Annual Enrollment Period (AEP) is well underway! SilverScript® Insurance Company (SilverScript), the nation’s second largest1 stand-alone Medicare Part D prescription drug plan sponsor, is pleased to:

• share great news about SilverScript Receiving an Overall 4-star Rating from the Centers for Medicare and Medicaid Services (CMS),
• offer additional 2016 AEP brochures with easy online ordering, and
• recap CMS provider guidelines.

*Please see attached PDF for more information.

SilverScript® Insurance Company (SilverScript), the nation’s largest1 stand-alone Medicare Part D prescription drug plan sponsor, is pleased to update you on our 2017 Medicare Part D Prescription Drug Plans.

The following information highlights:

• The 2017 SilverScript Choice (PDP) and SilverScript Plus (PDP) plans featuring $0 deductible2 on all formulary drugs on all tiers, low premiums, and broad coverage,
• How you can order SilverScript informational brochures using an easy and enhanced online process,
• A snapshot of communications your current SilverScript patients have received, and
• Centers for Medicare & Medicaid Services (CMS) provider guidelines.

*Please see attached PDF for more information.

As a reminder, Qualified Medicare Beneficiaries (QMBs), including some UnitedHealthcare Medicare Advantage members, are not responsible for any remaining balance after payment from Medicare for covered services. The Centers for Medicare & Medicaid Services (CMS) guidelines state that Medicare-contracted care providers may not collect cost-share from these patients. To determine if you can bill Medicaid as the secondary payer, please review the information found in the Benefit Stage Qualifier field of the approved Medicare Advantage claim. Code 50 in that field indicates that the claim was paid under Part B benefits, even if the drugs were processed using a Part D Processor ID or control number. This is because Medicare Advantage, also known as Part C, combines Part A, Part B and Part D benefits. If this is the case and the member is an active QMB, you can bill the dollar amount found in the Qualifier Amount field to Medicaid. If Medicaid does reimburse you, that payment must be accepted as full payment. If a balance remains or you’re unable to bill Medicaid as the secondary payer, your office must provide medications or supplies to UnitedHealthcare Medicare Advantage members without billing them for the balance. Care providers who bill patients who are QMBs for any remaining balances may be penalized as established in Section 1902(n)(3)(C) of the Social Security Act. If you have any questions, please call the following OptumRx Help Desk numbers any time. Thank you.