According to Minnesota Department of Human Services (DHS), there are Medicaid eligible individuals whose January health plan enrollment was cancelled or not processed. These members have been enrolled in Fee For Service Medicaid for the month of January. Therefore, if the member believes that they are eligible for State programs and the health plan claim is rejecting, please try submitting the claim to DHS under Fee for Service.

Greetings,   Please distribute the attached Quarterly Notification to all of your affiliated pharmacies located in the state of Texas.   If you have any questions, please do not hesitate to contact us.   Thank you.

Please note Sanford Health Plan is implementing a new copayment structure effective January 1, 2016. This change ONLY affects Sanford Health employees enrolled in the Sanford Group Health insurance plan. The new structure, plan information, and sample ID cards are presented below for your reference. Sanford Group Health Plan will have the following two tier generic drug structure:  Tier 1 – Generic Drugs $12 copay when retail cost is under $75  Tier 2 –Generic Drugs $30 copay when retail cost is $75 or greater If you have questions in regards to this change, please contact our Pharmacy Management Team at .855.305.5062. Please note: As of Dec. 28, 2015, this is a new phone number from previous communications. Important: This only affects Sanford Health employees enrolled in the Sanford Group Health insurance plan.

As of January 1, 2016, claims for Multi-Ingredient Compounds (MICs) will process according to the Cigna- HealthSpring Medicare Part D Formularies.  This means that each ingredient within a compound will pay or reject based on the specific ingredient‟s Formulary status. Part D products with Prior Authorization (PA), including B vs. D and Step Therapy (ST) will be subject to Formulary rules. Non-Formulary (NF) ingredients will reject as such. o The pharmacy will have the option to:  Submit a coverage determination for the rejected ingredients (PA, ST or NF); or  Resubmit a MIC claim with the rejected ingredients (PA, ST or NF) by submitting a submission clarification code (SCC) value of „08‟. This means that the non-covered drugs will process at $0 and by submitting the „08‟ that you are accepting payment for this amount as the entire payment. CMS does not allow pharmacies to charge the beneficiaries any more than their adjudicated co-payment. 

Catamaran, an Optum Rx Company, will manage claims processing for members of Memorial Hermann Health Solutions. Please note:  All members of Memorial Hermann Health Solutions will receive a new member identification (ID) card as shown below.  Please process prescriptions online using the Memorial Hermann Health Solutions ID card information.