THERDOSE screening monitors single ingredient and combination acetaminophen products across multiple claims to determine cumulative daily use. If claims indicate that acetaminophen usage exceeds the U.S.  Food and Drug Administration (FDA)-approved maximum daily dose of 4 gm/day, the THERDOSE edit produces a soft reject: Drug Utilization Review (DUR) Reject 88.

MedImpact Healthcare Systems, Inc. began processing for Vensurance as of 9/1/2016.

Since you have already agreed to participate with MedImpact, there will be no information for you to return. Enclosed please find the following information to assist you in processing claims:

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.