MedImpact Healthcare Systems, Inc. processes pharmacy claims for Medica Health Plans MINNESOTA Medicaid membership. Effective 1/1/2016, ~175,000 new members will transition to Medica from other Minnesota Health Plans. Consequently, the following information will be beneficial in processing claims for this membership.

The governors of Alabama, Illinois, Georgia, Missouri, New Mexico and Texas have declared States of Emergency due to Storm Goliath. Due to this issuance, Express Scripts has implemented Emergency Refill Too Soon procedures in the states of Alabama, Illinois, Georgia, Missouri, New Mexico and Texas for Part D and Medicare Advantage plans. Effective immediately, if a patient from the disaster area attempts to fill a prescription for lost or damaged medication resulting from the disaster, and the claim rejects with NCPDP Reject 79 "Refill Too Soon," the pharmacy should enter override code 91100000001 in NCPDP vD.0 field 462-EV "Prior Auth Number Submitted."

What You Need to Know Health Partners Medicare has four benefit designs for members to choose from. The plan designs are as follows: Basic, Prime, Prime Plus and Special. Health Partners has a closed, four-tier formulary for its Health Partners Medicare Prime and Health Partners Prime Plus recipients; and a closed one-tier formulary for its Health Partners Medicare Special recipients. The Pharmacy benefit plan design and benefit package is new for 2016 and is described below.