Please be alerted that beginning on October 21, 2016, at 11:00 p.m. CST until 11:45 p.m. CST OptumRx Administrative Services, LLC, will experience a Point of Sale Claims Processing Outage on a portion of our business. The outage is due to an OptumRx scheduled system enhancement. Please reprocess claims after 11:45 pm CST on October 21, 2016.

Due to this maintenance we would like to remind you that there may be a delay in the posting of your 835 files by 1-2 business days for the affected pay cycle.

OptumRx apologizes for any inconvenience this may cause. OptumRx strives to prevent system processing outages. Your assistance in servicing patients and resubmitting claims is greatly appreciated.

On July 22, 2016, Express Scripts issued a communication indicating that the Louisiana State-imposed $0.10 provider fee on prescription drug claims did not apply to Medicare claims. This is a correction to that communication.

Express Scripts network pharmacies should not be submitting the $0.10 provider fee to Express Scripts for Medicare claims; however, pharmacies are still required to remit the $0.10 provider fee to the Louisiana taxing authority for all prescription drug claims, including Medicare claims.

Express Scripts reserves the right to recoup the $0.10 provider fee from network pharmacies if they have inappropriately charged the $0.10 fee on Medicare Part D claims after July 1, 2016.

Dear Pharmacy Provider,

Please find attached the 2016-2017 MagellanRx Pharmacy Network Fee Schedule VAC-16 which updates the current reimbursement for vaccines covered under our Commercial and Medicaid lines of business that elect to cover vaccines along with Medicare Part D:

• VAC-16 replaces Pharmacy Network Fee Schedule VAC-15 and will be utilized for Medicare Part D and Commercial and Medicaid plans where vaccines are covered under the pharmacy benefit for the 2016-2017 flu season.

October 17, 2016

Dear Pharmacy Network Provider,

In an effort to promote vaccine administration in the pharmacy, please make a concentrated effort to:

• Register as an Immunization Provider in NCPDP

This will enable us to identify and promote your service for Avera subscribers.

If you have any questions, please email us at Pharmacynetwork@performrx.com

Sincerely,

PerformRx

Pharmacy Network Department

Process for durable medical equipment (DME) billing for pharmacies

AmeriHealth Caritas Iowa has received a number of inquiries from pharmacies about our DME billing process. Here are the key things pharmacies need to know when submitting DME claims:

• PerformRx is not able to process DME claims through their pharmacy point-of-sale system.
• Pharmacies that provide DME supplies must submit claims to AmeriHealth Caritas Iowa in order for claims to be processed.
• To submit a DME claim, pharmacies and/or DME suppliers can use the CMS-1500 professional claim form and submit electronically or via paper.