This week's Advocacy Center Update includes information on NCPA communications with CMS regarding MAC requirements, Medicaid FULs, Phase 2 of the HIPAA Audit program, and more!

Due to system errors, Medicaid is extending benefits to all members through April 30th   From:              Passport Health Plan Sent:               April 1, 2016 To:                   All Passport Providers   Background:   The Department for Medicaid Services (DMS) has notified Passport Health Plan of issues with the new benefind system, which processes all benefit programs administered by the Department for Community Based Services.  It has resulted in discontinuation letters being sent to Medicaid members in error or the system incorrectly showing an individual as ineligible for Medicaid.  The Cabinet for Health and Family Services is taking action to ensure that no individual loses benefits as a result and has asked MCOs to assist with communicating how DMS would like this matter to be handled.  If a person was eligible for Medicaid benefits in March, the person will automatically be eligible for benefits in April.    The Cabinet and DCBS are working with its technology partner, Deloitte, on system issues to stop the incorrect notices and properly reflect eligibility.  DMS requests that providers continue to provide necessary services and prescriptions to members during this time.   Provider Action Needed:   Please continue providing services to our members and follow your normal process when verifying eligibility. Should you have questions or concerns, please call Provider Services at 1-800-578-0775.   

Reminder - Newborn Claim Processing Florida Medicaid Molina Healthcare of Florida As previously communicated on February 26, 2016, for the first thirty (30) days of newborn membership, pharmacy claims should be processed under the mother’s Member ID. After the 30-day grace period, please ask the parent/guardian to present the newborn’s new ID card for processing future claims. For any issues with processing a claim, please contact Molina Healthcare. RXBIN: 004336 RXPCN: ADV RXGRP: RX0794 Member ID Format 9 digits Person Code 2 digits

ACTION REQUIRED: Beginning on March 27, 2016, the following or similar reject may have occurred on some CVS Caremark® claims: Reject 56: <Non-Matched Prescriber ID>. This unanticipated issue has been resolved. If you have not already done so, please assist plan members and resubmit applicable rejected claims. Contact the plan member as appropriate once a paid claim has been captured. If the plan member has paid cash and received the medication, please resubmit the claim and refund the member as appropriate. Note: Valid Prescriber ID rejects may still occur. Follow your pharmacy’s procedures for processing Prescriber ID rejects. As a reminder, per the CVS Caremark Provider Manual, from time to time, unscheduled system maintenance or other circumstances may occur when the adjudication platform(s) may not be available to adjudicate claims for a limited time. At any time, a Provider may contact the Pharmacy Help Desk for assistance or information regarding any claim processing related question. Pharmacy Help Desk Representatives are available 24 hours a day, 7 days a week.