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.

OptumRx Help Desk Contact Information 

• AARP® MedicareComplete® and UnitedHealthcare MedicareComplete Plans: 877-889-6510  UnitedHealthcare Medicare/Medicaid Plans: 877-305-8952 
• AARP® MedicareRx, United MedicareRx, UnitedHealthcare MedicareRx Plans: 877-889-6481

To help minimize processing errors, please confirm the information on the member’s ID card before submitting a prescription claim.

Please be advised that, effective 1/1/2017, MedImpact will be implementing new POS edit functionality to support mandatory 2017 CMS requirements for Medicare Part D claims processing.

*Please see attached PDF for more information.

The new Covered Drug List (closed formulary) includes thousands of generic and brand drugs; however, not every drug will be covered. When a wide range of successful, lower-cost alternatives are available, higher-cost drugs may not be covered for members whose plans follow our new Covered Drug List. Members with this formulary have received a letter from Blue Cross Blue Shield of Louisiana (BCBSLA) explaining the change and where to find the list: www.bcbsla.com/CoveredDrugs. Members may also call the Pharmacy number on their ID card: 866.781.7533.

*Please see attached PDF for more information.