Starting January 1, 2018, some UnitedHealthcare Dual Complete plan members in Arizona, New York and Tennessee will have new member group (Grp) codes for prescription drug or Part D coverage.

Beginning immediately CalOptima’s Medi-Cal Line of Business will require the use of the Patient Residence Code, which is found in field 384-4X of the Commercial NCPDP Payer Sheet, to be listed on ALL CalOptima Medi-Cal claims.

Effective January 1, 2018 contracted UnitedHealthcare Medicare Part D Home Infusion pharmacies must submit appropriate PRC (Patient Residence Code) and PST (Pharmacy Service Type) codes to receive an approved claim for home infusion drugs.

As has been previously communicated, CVS Caremark requires all contracted network providers to complete General Compliance and Fraud, Waste and Abuse (FWA) training on behalf of our client PDP plans.

Effective January 1, 2018, Blue Cross Community Health Plans experienced a large increase in their membership.