Effective November 1, 2016, CVS Caremark® will begin to administer the prescription benefits for Aetna Better Health of Texas STAR Kids. Please update or create plan member profiles to reflect the changes regarding the following new plan adjudicating through CVS Caremark.

*Please see attached PDF for more information.

Effective November 1, 2016 – US Script will be changing its name to Envolve Pharmacy Solutions. Please make a note of it in your records.

Please contact Envolve Pharmacy Solutions if you have any questions regarding this company name change. We look forward to working together to provide quality pharmacy services to our members.

You are receiving this notice as a reminder of the proper usage for Submission Clarification Code (SCC) 42.

SCC 42 use should be reserved for providing clarification on the reason the pharmacy is overriding a claim rejection. This should be done based on evidence obtained for validating the Prescriber ID submitted as active and valid on the Date of Service. Routine use of SCC 42 without a rejection is considered non-compliant with established protocol.

PLEASE NOTE: It is inappropriate to use SCC codes without appropriate evaluation of the situation on a rejected claim. Selection of the SCC must be in accordance with the situation for which an override is being placed. SCC 42 should never be included on an initial claim transition.

ACTION REQUIRED: Please immediately alert the staff to only submit SCC where appropriate for a rejection and only based upon accurate information reflecting the reason for the selected SCC code.