West Virginia Medicaid Aetna Better Health of West Virginia Effective October 1, 2016, CVS Caremark® will begin to administer the prescription benefits for Aetna Better Health of West Virginia. Please update or create plan member profiles to reflect the changes regarding the following new plan adjudicating through CVS Caremark. RXBIN: 610591 RXPCN: ADV RXGRP: RX8838 Member ID Format: 11-14 digits Person Code: Not required

In this issue: Appropriate Billing of Medications • The CVS Caremark® Pharmacy Performance Department is providing its Network Pharmacies with a reminder regarding your pharmacy’s contractual requirements with respect to accurate claims billing and dispensing. This information will assist your pharmacy in complying with the CVS Caremark Provider Agreement (which includes the Provider Manual) and to prevent audit chargebacks. • The CVS Caremark Audit Department is providing basic information on appropriate billing of the triptan category of medications to help prevent claim discrepancies. • If you have any questions or concerns related to this topic, please contact the Pharmacy Audit department at 1-866-465-2508.

New Implementation UPDATED 8-31-16 Effective September 1, 2016, CVS Caremark®will begin to administer the prescription benefits for Passport Health Plan. Please update or create plan member profiles to reflect the following changes regarding the new plan adjudicating through CVS Caremark. RXBIN: 004336 RXPCN: ADV RXGRP: RX6420 Member ID Format: 8 digits, numeric Person Code: Not required Sheets: For additional claim processing information, refer to the CVS Caremark Payer Sheets at www.caremark.com/pharminfo > NCPDP Payer Sheets.

A. In the Georgia Addendum to Caremark Provider Agreement, Georgia Medicaid sub-section of the Provider Manual (beginning on page 97), the following language: "To the extent Provider provides Pharmacy Services to Eligible Persons who are enrollees under the Georgia Medicaid program administered by the Plan Sponsor, Provider agrees to the following:" is deleted in its entirety and replaced with the following: "To the extent Provider provides Pharmacy Services to Eligible Persons who are enrollees under the Georgia Medicaid program administered by a Care Management Organization ("CMO" or "Plan Sponsor"), Provider agrees to the following:" B. In the Georgia Addendum to Caremark Provider Agreement, Georgia Medicaid sub-section of the Provider Manual (beginning on page 97), the following new section is added: 31. "Provider shall comply with DCH lock-in programs applicable to an Eligible Person by referring the Eligible Person to the appropriate pharmacy."

Effective October 11, 2016, Argus will begin rejecting claims for the following two reasons: 1. Argus will reject transactions submitted with a decimal in the Diagnosis Code (NCPDP field 434-DO). NCPDP Reject Code 39 (Missing/Invalid Diagnosis Code) will be returned when decimals are submitted in any occurrence of the Diagnosis Code. Pharmacies should remove the decimals and resubmit the claim. The free-form message "FLD DO DIAGNOSIS CODE WITH DECIMAL WILL CAUSE CLAIM REJECTION EFFECTIVE 10/11/16" is currently being returned when a decimal is submitted in the diagnosis code fields in preparation for the hard rejection. 2. Argus will reject transactions containing lowercase letters in an alphanumeric field. NCPDP Reject Code 614 (Upper Case Required) will be returned when lowercase characters are submitted in fields defined as alphanumeric. Pharmacies should change data to uppercase and resubmit the claim. Note: The Patient Email Address (NCPDP field 350-HN) is exempt from the lowercase edit and emails may continue to be submitted in mixed case characters. Argus has submitted a request to NCPDP to have the character designation for email fields redefined to allow mixed case alpha characters.